Closer to a family

Along with Dr. Steve Young, former UNC faculty member Dr. Bruce Lessey, develop a test for fertility’s foe – endometriosis.

By April A. Morris – Updated April 24, 2014
Source: Greenville Journal- See more at: http://www.greenvillejournal.com/life-culture/3124-closer-to-a-family.html#sthash.Efe0AtgQ.dpuf

For couples that can’t conceive a baby within a year – a segment that includes 6 percent of U.S. women aged 15-44 years old – the next stop is often a fertility clinic for tests, procedures and a lot of uncertainty. 

Thanks to the research of an Upstate physician, some women struggling with infertility may be able to bypass one of the most common alternative treatments: the multi-week and multi-step in-vitro fertilization (IVF) procedure.

For 25 years, Dr. Bruce Lessey with the Fertility Center of the Carolinas has researched the impact of endometriosis on fertility and how its treatment might lead to successful pregnancies. 

Often painful, endometriosis is a condition that occurs when tissue that normally lines a woman’s uterus, called endometrium, grows outside the womb. Lessey said endometriosis is the cause of infertility issues for up to 45 percent of couples he treats. 

For that reason, couples should always explore what role it may play in their infertility before undertaking the potential mental and economic strain of IVF, an expensive procedure rarely covered by health insurance, he said.

“Inflammation is a key element” in endometriosis, Lessey said. Inflammation of the uterine lining is a part of normal menstruation, but “there has to be a process to shut it off so a woman can have a baby,” he said. With endometriosis, inflammation doesn’t resolve and creates an immune response that won’t go away. 

However, it is reversible, Lessey said. The preferred treatment is surgery. Endometriosis causes “implants” of abnormal cells, he said. “You remove the implants and the inflammation goes away quickly.” 

After treatment, Lessey says his patients experienced a 70 percent pregnancy rate, often without IVF. Many are pregnant within the first two months post-op, he said. “They’re just not ready to believe that – they think they’re infertile, and they aren’t.” Because endometriosis can be mistaken for other conditions like irritable bowel syndrome and bladder issues, there is an 11-year diagnosis delay of the condition in the United States, Lessey said. 

Some doctors do not consider endometriosis as a cause for IVF failures, he said. Lessey cited a patient who underwent seven failed IVF procedures and came to him despite other doctors’ encouragement to try IVF again, he said. 

“She did have endometriosis, we did fix it. The next month, she had embryos implanted and is now 22 weeks pregnant with twins,” he said.
Lessey and Dr. Steven L. Young, associate professor in obstetrics and gynecology at the University of North Carolina Chapel Hill, have discovered through research that endometriosis is also connected to how the body reacts to progesterone, a hormone that plays a vital role in maintaining a pregnancy. Progesterone resistance is a normal occurrence in a woman’s menstrual cycle and the endometriosis “actively turns off the receptors for progesterone,” said Lessey. “That process comes earlier in women with endometriosis, caused by the inflammation.” 

The pair is presenting their findings at the World Congress on Endometriosis in Brazil next week.

In addition, Lessey and Young have developed an endometriosis test, which detects an inflammatory marker associated with endometriosis. Currently used for research purposes, the test has revealed that roughly 96 percent of women who have endometriosis also have the inflammatory marker, he said.
“We can find almost every person with endometriosis, no matter what stage or grade they have. It’s the first test of its kind and it will change the way we approach it. So diagnosis over 11 years will go away,” Lessey said.

Using the test to determine if endometriosis is the cause of unsuccessful IVF procedures “could save couples millions and millions of dollars of wasted money,” he said. - See more at: http://www.greenvillejournal.com/life-culture/3124-closer-to-a-family.html#sthash.Efe0AtgQ.dpuf

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