QC: Fertility and Adenomyosis

Dr. Naomi Whittaker shares critical distinctions between diffuse and focal adenomyosis and their impact on fertility. She highlights how adenomyosis is often over-diagnosed on ultrasound while explaining that diffuse adenomyosis rarely affects fertility, though focal adenomyomas require surgical intervention by fertility-friendly specialists.

• Diffuse adenomyosis is more common in women who have had children and typically doesn't impact fertility
• Adenomyosis is frequently over-diagnosed on ultrasound as technology improves
• Finding adenomyosis on imaging doesn't necessarily mean it's clinically significant 
• Focal adenomyosis (adenomyomas) can cause infertility but are surgically treatable
• Surgeon choice is critical for fertility preservation
• Concerning cases exist where fallopian tubes were removed without patient consent
• Important to choose fertility-friendly surgeons who handle tissue delicately

Send your questions by using the link in the top of the description of this podcast episode, by emailing contact@endobattery.com, or by visiting the endobattery.com contact page.

Chapters

• 0:00 Welcome to EndoBattery's Quick Connect
• 0:50 Introducing Dr. Naomi Whitaker
• 1:28 Understanding Adenomyosis Types
• 2:10 Adenomyomas and Fertility Impact
• 4:00 Surgeon Choice Matters for Fertility
• 4:46 Episode Wrap-Up and Contact Info

Transcript

Speaker 1: 0:00

Life moves fast and so should the answers to your biggest questions. Welcome to EndoBattery's Quick Connect, your direct line to expert insights Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need. No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers. I'm your host, alana, and it's time to connect.

Speaker 1: 0:50

I'm joined at the table today by Dr Naomi Whittaker, who is the founder of RRM Academy and is an OBGYN fertility surgeon focused on women's restorative reproductive medicine, compassionate healthcare and education. Dr Whitaker is a board-certified OBGYN, anda fellowship-trained surgeon who specializes in the Creighton Model Fertility Care System and Napro Technology, which works cooperatively with women's body to treat the underlying cause of gynecologic issues and infertility, such as endometriosis and PCOS. Dr Whitaker helps women improve their gynecologic health and avoid or achieve pregnancy in accordance with their natural fertility, using the latest research, medicine and surgery. Let's get started, as a lot of us that are struggling with fertility not only have endometriosis, but have adenomyosis as well. Is that something that you kind of deal with on a daily basis as part of helping those achieve success in fertility?

Speaker 2: 1:44

Absolutely. So I had to really do my own research on adenomyosis because there's really not good information out there. So there's technically two different types of adenomyosis there's diffuse and there's focal. So diffuse is more common in women who have had children and does not cause infertility but can cause the symptoms like fullness, heavy bleeding. But the good thing is that shouldn't really affect fertility.

Speaker 2: 2:12

It's very often visualized on ultrasound. In an article that I read analyzing many, many studies and summarizing the findings, it compared it to the boy who cried wolf. So adenomyosis is over called on ultrasound because obviously we know endometriosis is missed more often than not by ultrasound and MRI. But they might see some junctional changes or whatever the ultrasound findings are in a large uterus. So oh, it must be that right. Just because you find it doesn't mean it's clinically significant. And now that our ultrasound technology is more clear than it used to be, we're finding it more. And now we're over calling it based on what I've been able to find and what I see clinically.

Speaker 2: 2:55

I see it frequently and I don't see other signs of issues. If it's just that, for example and I don't consider that in my other than management of symptoms, I don't consider that as a barrier to conceiving. Now it's very different. Someone messaged me today they have a seven centimeter adenomyoma. Now that's very different. That's evidence of focal adenomyosis, so a big nodule or area of endometriosis growing into the muscle of the uterus, and so those do cause infertility. But the good thing is those are resectable. You just treat it very similarly to endometriosis and it's definitely trickier surgically.

Speaker 1: 3:38

But and from my understanding and maybe I'm wrong on this but doing those does increase risk, sometimes with fertility, depending on who you see. Like you wouldn't want to see, just anyone to see, no matter what.

Speaker 2: 3:51

Right Period If you are interested in fertility, and I think that's something I really want to bring into light, is that who your surgeon is matters more than anything. Right Because? Because not only finding it all, but tissue handling, being very delicate with tissue I, the fallopian tubes you don't want to do that with these very strong instruments. Obviously you don't want to take out fallopian tubes without patient consent, which obviously happens a lot. I'm sure you've gotten those messages, like I have. I went under anesthesia. I woke up without a fallopian tube. I've seen it on patients who go to surgeons. They go there for fertility. The tube is taken out because they thought it was endometriosis. Pathology was negative for endometriosis on the tube. They took out the whole tube. So surgeon choice matters for someone who's fertility friendly, who really respects that, and so there's a lot to it that's touching the surface of it.

Speaker 1: 4:46

That's a wrap for this Quick Connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming, send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.