QC: Fertility Success with Adenomyosis: With Dr. Naomi Whittaker

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Dr. Naomi Whittaker explains the two types of adenomyosis and their differing impacts on fertility, revealing that the condition is often over-diagnosed on ultrasound. She emphasizes that surgeon selection is crucial for women with reproductive concerns, sharing concerning examples of unauthorized fallopian tube removals during surgeries.

• Diffuse adenomyosis is common in women who have had children and typically does not cause infertility
• Adenomyosis is often "over-called" on ultrasound as technology becomes more advanced
• Focal adenomyosis (adenomyomas) can cause infertility but are usually resectable with proper surgical techniques
• Choosing a fertility-friendly surgeon who respects reproductive goals is critical
• Proper surgical technique and tissue handling significantly impact fertility outcomes
• Patient autonomy and informed consent should always be respected during reproductive surgeries

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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
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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.

(00:47):
I'm joined at the table today byDr Naomi Whitaker, 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

(01:09):
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 into this.
Are you able to speak on thesuccess rate for those patients

(01:32):
that maybe have adenomyosis,because this is a big one for us
in the endometriosis community,as far as a lot of us that are
struggling with fertility notonly have endometriosis but have
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 (01:55):
Absolutely so I had to really do my own research on
adenomyosis because there'sreally not good information 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

(02:17):
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

(02:39):
we know endometriosis is missedmore often than not by
ultrasound and MRI.
But they might see somejunctional changes or whatever.
The ultrasound findings are anenlarged uterus.
So oh, it must be that right.
Just because you find itdoesn't mean it's clinically
significant.
And now that our ultrasoundtechnologies is more clear than
it used to be, we're finding itmore.

(03:01):
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 example,right and I don't, I don't
consider that in my other thanmanagement of symptoms.
I don't consider that as abarrier to conceiving.
Now it's very different.

(03:22):
Someone messaged me today theyhave a seven centimeter
adenomyoma.
Now that's very different.
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.

(03:43):
You just treat it verysimilarly to endometriosis.

Speaker 1 (03:46):
Now it's definitely trickier surgically but and from
my understanding, and maybe I'mwrong on this but doing those
does increase risk, sometimeswith fertility, depending on who
you see.
Like you wouldn't want to seejust anyone to see to do this,
no matter what Period.

Speaker 2 (04:02):
If you are interested in fertility and I think that's
something I really want tobring out today into light is
that who your surgeon is mattersmore than anything.
Right, Because not only findingit all, but tissue handling
being very delicate with tissueI see people on social media
even just grabbing the fallopiantubes.
You don't want to do that withthese very strong instruments.

(04:24):
Obviously you don't want totake out fallopian tubes.
You don't want to do that withthese very strong instruments.
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.
Path was negative forendometriosis on the tube.

(04:45):
They took out the whole tube.
So surgeon choice matter.
There's someone who's fertilityfriendly, who really respects
that, and so it's.
There's a lot to it.
We could definitely go into itmore.
That's touching the surface ofit, but number one respecting
autonomy.
Respecting that.
You know I have patients allthe time.
Are you going to take out mytube?

(05:05):
Are you going to take out myovary?
I mean, you know and I explainhow often I do that, which is
almost never, unless I think itlooks like there's a cancer I
pretty much try to save everyfallopian tube or ovary.
After you know, informeddiscussion with a patient, of
course, yeah, I'm sure there areexceptions in women who aren't
trying to.
I'm talking about trying toconceive population.

Speaker 1 (05:25):
Yeah, 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 in and I'll bring youthe expert answers using the

(05:46):
link in the top of thedescription of this podcast
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