QC: Fertility and Adenomyosis

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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

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Episode Transcript

Speaker 1 (00:00):
Life moves fast and so should the answers to your
biggest questions.
Welcome to EndoBattery's QuickConnect, your direct line to
expert insights Short, powerfuland right to the point.
You send in the questions, Ibring in the experts and in just
five minutes you get theknowledge you need.
No long episodes, no extra timeneeded, and just remember

(00:20):
expert opinions shared here arefor general information and not
for personalized medical advice.
Always consult your providerfor your case-specific guidance.
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect.

(00:50):
I'm joined at the table today byDr Naomi Whittaker, who is the
founder of RRM Academy and is anOBGYN fertility surgeon focused
on women's restorativereproductive medicine,
compassionate healthcare andeducation.
Dr Whitaker is aboard-certified OBGYN, anda
fellowship-trained surgeon whospecializes in the Creighton
Model Fertility Care System andNapro Technology, which works
cooperatively with women's bodyto treat the underlying cause of

(01:11):
gynecologic issues andinfertility, such as
endometriosis and PCOS.
Dr Whitaker helps women improvetheir gynecologic health and
avoid or achieve pregnancy inaccordance with their natural
fertility, using the latestresearch, medicine and surgery.
Let's get started, as a lot ofus that are struggling with
fertility not only haveendometriosis, but have

(01:34):
adenomyosis as well.
Is that something that you kindof deal with on a daily basis
as part of helping those achievesuccess in fertility?

Speaker 2 (01:44):
Absolutely.
So I had to really do my ownresearch on adenomyosis because
there's really not goodinformation out there.
So there's technically twodifferent types of adenomyosis
there's diffuse and there'sfocal.
So diffuse is more common inwomen who have had children and
does not cause infertility butcan cause the symptoms like

(02:07):
fullness, heavy bleeding.
But the good thing is thatshouldn't really affect
fertility.
It's very often visualized onultrasound.
In an article that I readanalyzing many, many studies and
summarizing the findings, itcompared it to the boy who cried
wolf.
So adenomyosis is over calledon ultrasound because obviously

(02:28):
we know endometriosis is missedmore often than not by
ultrasound and MRI.
But they might see somejunctional changes or whatever
the ultrasound findings are in alarge uterus.
So oh, it must be that right.
Just because you find itdoesn't mean it's clinically
significant.
And now that our ultrasoundtechnology is more clear than it
used to be, we're finding itmore.

(02:50):
And now we're over calling itbased on what I've been able to
find and what I see clinically.
I see it frequently and I don'tsee other signs of issues.
If it's just that, for exampleand I don't consider that in my
other than management ofsymptoms, I don't consider that
as a barrier to conceiving.
Now it's very different.

(03:11):
Someone messaged me today theyhave a seven centimeter
adenomyoma.
Now that's very different.
That's evidence of focaladenomyosis, so a big nodule or
area of endometriosis growinginto the muscle of the uterus,
and so those do causeinfertility.
But the good thing is those areresectable.

(03:32):
You just treat it verysimilarly to endometriosis and
it's definitely trickiersurgically.

Speaker 1 (03:38):
But and from my understanding and maybe I'm
wrong on this but doing thosedoes increase risk, sometimes
with fertility, depending on whoyou see.
Like you wouldn't want to see,just anyone to see, no matter
what.

Speaker 2 (03:51):
Right Period If you are interested in fertility, and
I think that's something Ireally want to bring into light,
is that who your surgeon ismatters more than anything.
Right Because?
Because not only finding it all, but tissue handling, being
very delicate with tissue I, thefallopian tubes you don't want
to do that with these verystrong instruments.

(04:13):
Obviously you don't want totake out fallopian tubes without
patient consent, whichobviously happens a lot.
I'm sure you've gotten thosemessages, like I have.
I went under anesthesia.
I woke up without a fallopiantube.
I've seen it on patients who goto surgeons.
They go there for fertility.
The tube is taken out becausethey thought it was
endometriosis.
Pathology was negative forendometriosis on the tube.

(04:39):
They took out the whole tube.
So surgeon choice matters forsomeone who's fertility friendly
, who really respects that, andso there's a lot to it that's
touching the surface of it.

Speaker 1 (04:46):
That's a wrap for this Quick Connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming, send them inand I'll bring you the expert
answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at endobatterycom or visitingthe endobatterycom contact page.

(05:11):
Until next time, keep feelingempowered through knowledge.