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Questions & Answers

What is Pelvic Pain?

Pelvic pain is any pain in the lower abdomen or pelvis. It can present suddenly in which case it is called 'acute pelvic pain'. If the pain lasts more than 6 months it is called 'chronic pelvic pain'. Pelvic pain is very common and chronic pelvic pain affects up to 1 in 6 women. Pelvic pain has many different causes and so it is important for the doctor to take a detailed history of the problem and to do a careful examination of the abdomen and an internal vaginal examination to help reach a diagnosis.
A number of different tests may be done to help reach a diagnosis, this will usually include an ultrasound scan of the pelvis, swabs for pelvic infection and sexually transmitted infections and a urine test. If there are bowel symptoms or bladder symptoms you may be referred to another specialist, such as a gastroenterologist or an urologist.
A laparoscopy may be recommended. This is an operation carried out under general anaesthetic. A small cut is made under your belly button and a small telescope is inserted into your abdomen to look at the reproductive organs to see if there is any disease or damage to cause the pelvic pain.

Causes of chronic pelvic pain
Long-term pelvic pain may have one cause but often is caused by a combination of physical, psychological and social factors. These include:

Endometriosis: this is a condition where cells of the lining of the womb are found elsewhere in the body, most commonly in the pelvis around the ovaries

Adenomyosis: this is a type of endometriosis where the cells lining the womb are found in the muscle wall of the womb

Adhesions: area of scar tissue caused by previous infection, surgery or endometriosis
Interstitial cystitis: inflammation of the bladder

Musculoskeletal pain: pain in the joints, ligaments, muscles and bones

Irritable bowel syndrome (IBS)

Trapped or damaged nerves

Depression

Previous or ongoing traumatic experiences such as sexual abuse

Unknown

Treatment
Treatment will depend on the underlying cause or causes of the pain. It may include surgical treatment, or medications in the form of tablets or injections. Complementary therapies can be helpful for some individuals.

Mr Nardo and his multidisciplinary team will support you in investigating the cause of pelvic pain and in offering appropriate treatment and support when needed.

What are Sexually Transmitted Diseases?

Sexually transmitted diseases (STDs, also known as sexually transmitted infections STIs) are diseases passed on through intimate sexual contact. These infections can be passed on during vaginal, anal or oral sex as well as just through genital contact with an infected partner. The incidence of such infections is increasing with most of those affected being between the ages of 16 and 24 years.

Chlamydia
Chlamydia is an STI caused by a bacterium called Chlamydia trachomatis. Most people who get this infection do not have any symptoms and many cases remain 'silent' and undiagnosed. It can be easily diagnosed through a simple vaginal swab or urine test. Undiagnosed Chlamydia can lead to more serious long term problems and infertility.

Genital warts
Genital warts are caused by a viral skin infection as a result of infection with the human papilloma virus (HPV). Small fleshy lumps are seen around the genital area. It is possible to pass on the infection without penetrative sex as HPV is spread by skin to skin contact. Genital warts are most common amongst young adults. Several treatments are available including, creams and cryotherapy (freezing).

Genital Herpes
Genital herpes is caused by the herpes simplex virus (HSV) type 1 or 2. It causes painful blisters to appear on and around the genitals. HSV is very infectious passes easily between people by direct contact. Genital herpes is transmitted from one person to another by having sex. I t is possible for an individual with no symptoms to pass the condition onto a sexual partner. Once infected the virus stays dormant most of the time with 80% of people unaware they have been infected as there are no symptoms initially. Genital herpes is especially common amongst young people aged 20-24years.
There is no cure for herpes but the symptoms can be relieved by antiviral medicines and with time the frequency and severity of attacks reduces.

Gonorrhoea
Gonorrhoea is caused by a bacterium called Neisseria gonorrhoeae. The symptoms of infection are a discharge from the vagina or penis and pain when passing water. The bacteria are found in the discharge and it is easily transmitted between people during sex. Gonorrhoea can be easily diagnosed through a swab and it is treated with antibiotics. If it is not treated long term fertility problems can occur.

Syphilis
Syphilis is caused by a bacterium and is usually caught through unprotected intercourse with an infected individual. There are three stages of the disease. Stage 1 is the presence of a painless genital or oral ulcer which is highly contagious, it is present for between 2 and 6 weeks. Stage 2 presents with a skin rash and sore throat, which usually last a few weeks. Stage 3 can result in long term damage to the body, leading to blindness, stroke and even death. If diagnosed early it is easily treated with antibiotics.

Trichomoniasis
Trichomoniasis is caused by a small parasite called Trichomonas vaginalis. Sometimes it is not diagnosed because there are no symptoms. Women may have soreness and itching around the vagina and a vaginal discharge, men may experience pain after passing water or after ejaculation. Trichomoniasis is transmitted through unprotected intercourse, it is treated with antibiotics.

Human Immunodeficiency Virus (HIV)
This virus attacks the immune system, leading to increase risk of developing a serious infection or diseases such as cancer. HIV destroys CD4 cells which are responsible for fighting infection, as the number of CD4 cells falls the ability to resist infection is reduced. HIV is transmitted through the exchange of bodily fluids, which most commonly happens during unprotected sex. Intravenous drug users who share needles can infect one another. There is no cure for HIV nor any vaccine. There are treatments which can help infected individuals stay healthy.

Will the Endometriosis disappear if I get pregnant?

No. Some women find that their pelvic pain symptoms are reduced or settled during pregnancy, particularly in the third trimester. However, some women experience a worsening of symptoms, particularly at the beginning.
It is thought that the high levels of progesterone produced during pregnancy suppress the growth of the endometriosis lesions, but it may also be true that the lack of menstruation during pregnancy has a positive effect. It has to be emphasised that the improvement in symptoms, if any, are only temporary. Many women will experience a recurrence of their endometriosis and its symptoms within a few years and some will experience a recurrence soon after resuming their normal periods.

Is Endometriosis inherited (genetic)?

The exact cause of endometriosis is not yet known, but research demonstrates that first-degree relatives of women with this gynaecological disease are more likely to develop endometriosis and suffer from it.

Is Endometriosis cancer?

No, endometriosis is not the same disease as cancer. Although some recent research from Sweden has suggested that some women with endometriosis may be at a slightly higher risk of developing certain types of cancer this is still very controversial. The same authors found no significant difference between women with endometriosis who have had children and those who have not conceived regarding cancer risk. It is too early to use these data to give advice to gynaecologists and women with endometriosis about screening programmes and improved treatments.

IVF-related Frequently Asked Questions

Can I continue to have acupuncture while on a treatment cycle?

Answer: Yes, it is completely fine to continue having acupuncture during your treatment cycle.

How long will the ovarian stimulation cycle take?

Answer: This will depend on the type of treatment you are having and your individual response to the drugs used to induce stimulation of the ovaries. On average it takes between 10-15 days of FSH or hMG injections before the eggs are collected. There is then about 14-18 days before you find out if the treatment has been successful (i.e., do a pregnancy test) or alternatively before your period starts.

How can I cope with the 2-week wait after embryo transfer?

This is certainly the toughest time of the cycle. It is advisable to find support in your partner and relatives. The IVF clinic often advises to stay in touch with the nurse coordinator of the treatment cycle and offers appointments to see the fertility counsellors to provide the necessary help and psychological support.

Will stress affect negatively the chance of IVF success?

There is no robust evidence that stress negatively impacts on the chance of pregnancy. Therefore it cannot be concluded that stress has an harmful correlation with IVF success rate. Novertheless, the more stressed you are the more difficult the experience of IVF treatment is likely to be. For such reason the mind/body therapy during treatment might be beneficial.

Can progesterone vaginal pessaries cause some bleeding?

It is not unusual to have some vaginal spotting or brownish discharge whilst using the pessaries. This is often caused by some irritation to the cervix (neck of the womb) or the vagina and is not indicative of a failed IVF cycle at all. It is important that if you experience vaginal bleeding you do continue using the pessaries and any other medications you are on until you have spoken to the nurse coordinator.

For any other questions related to your IVF treatment please consult the FAQs section on the NorthWest Fertility website (www.northwestfertility.co.uk) or contact your nurse coordinator at the IVF unit where you are undergoing treatment.

What reproductive problems are helped by IVF?

Assisted reproductive techniques by means of in-vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI) can help couples with a variety of fertility problems, including damaged or absent fallopian tubes, endometriosis, difficulty ovulating, diminished ovarian reserve, abnormal sperm parameters and uterine abnormalities. Often infertility can be caused by a combination of problems, both from the female and male factors. Sometimes the exact cause of infertility is unknown, and even then conventional IVF can help. However, IVF can also help achieve a pregnancy single women and same sex couples who have no fertility problems other than the lack of the necessary gametes for appropriate fertilisation and reproduction.

I have heard about ovarian reserve testing. I am in my thirties and I am worried about my fertility. What do you advise?

Chronological age is very important in consideration of fertility potential as it is closely related to the ovarian performance. However, the relationship between age and ovarian reserve is highly variable. Amongst the currently available ovarian reserve tests, anti-Müllerian hormone (AMH) and antral follicle count (AFC) are reliable markers of what is left in the ovary at a point in time. Therefore my advice would be to have a blood test for AMH levels and a pelvic scan to assess the ovaries.

I suffer from pelvic pain and period problems. I have to take time off work and my social life is affected too. What can I do?

Lower abdominal pain and period problems can be very frustrating and debilitating. The commonest causes for these symptoms include: endometriosis, fibroids, pelvic adhesions, ovarian cysts, and non gynaecological conditions such as irritable bowel syndrome and interstitial cystitis. You should ask your GP to make a referral to a gynaecologist, who will perform an ultrasound scan at the same time of consultation. A series of tests may follow dependant on the suspected diagnosis. Laparoscopy (keyhole surgery) can be performed for the diagnosis and/or treatment of the gynaecological conditions.

We have been told that we need IVF treatment. What does this involve? Are there any alternatives?

In the UK, 1 in 6 couples experience difficulties in conceiving. IVF (in-vitro fertilisation) is a form of assisted conception that involves the administration of hormones, the retrieval of eggs from the ovary and the fertilisation of these with the sperm outside the body. Subsequently the embryos are transferred into the uterus through the cervix. The chances of live birth are around 40% for women younger than 39 years. If the only cause of infertility is tubal damage, in selected cases it is possible to overcome the problem by surgery.