Fertility Endometriosis Dialogues

Recent Posts
© Copyright FED. Site developed by Smith Aegis Plc
 

What we do

The FED

What is FED

FED is a dedicated platform that is focused on infertility and endometriosis grounded in principles of best practice and evidence based care.  Individuals or couples requiring a medical consultation may book an online or face-to-face appointment for appropriate advice.

Our team comprises of specialists in fertility, endometriosis with close collaboration with other inter-related disciplines and support teams

Read more

Meet the Team

Charles-Muteshi-profile-photo

Dr Charles Muteshi

Founder and Medical Director

Dr Muteshi finished his specialist training in Obstetrics and Gynaecology at Aga Khan University, Nairobi before proceeding to the University of Oxford for a Clinical Research Fellowship. At Oxford he focused his interest on endometriosis and assisted reproductive technologies leading to several peer reviewed publications. In addition, he pursued his interest in minimal access surgery where he worked with Endometriosis CaRe Oxford, part of the Nuffield Department of Women’s and Reproductive Health at the University of Oxford over a period of five years before returning to Kenya. Currently, Dr Muteshi is Assistant Professor at Aga Khan University, Nairobi in the Department of Obstetrics and Gynaecology where he heads the sections of Gynaecology and Fertility. Dr Muteshi also leads the multidisciplinary team involved in endometriosis treatment and research at the University.

Our Services

Fertility

Fertility assessment

We pride ourselves as a one-stop clinic for fertility assessment. This includes comprehensive pelvic ultrasound scanning by the fertility specialist that also involves checking fallopian tubes for patency with the HyCoSy technology. Hormone profile as well as semen analysis are undertaken, and results discussed in the single visit. You will have the opportunity to leave the clinic with a proper diagnosis and complete plan of management. It is important that both partners attend together.

Ovulation induction

The commonest cause of lack of ovulation is polycystic ovarian syndrome. A dedicated team of specialists will monitor ovulation induction to ensure that other than achieving a pregnancy, the risk of multiple pregnancy is minimized.

Specialised treatment for rare cases of lack of ovulation such as pituitary failure is carefully administered by the fertility specialist.

Intrauterine insemination

In the event natural conception is rendered unlikely, intrauterine insemination is a suitable alternative. It is important that the fallopian tubes are patent and the sperm parameters are normal.

 

This is either done in a natural cycle or following ovulation induction treatment.

In vitro fertilization (IVF)

Damaged fallopian tubes as well as very poor sperm count account for the common indications for in vitro fertilization. This also includes unexplained subfertility for a duration longer than 2 years. Considering the complexity of IVF treatment, each couple are treated differently with an individualized treatment plan tailored to their unique situation. Either the long agonist or antagonist protocol is chosen for each individual case.

Fertility preservation

Treatment for cancer now guarantees long-term survival when diagnosis is made at early stage. Unfortunately, chemotherapy or radiotherapy may cause irreversible damage to the ovaries or testes. We offer the opportunity to discuss fertility preservation for sperm, oocytes or embryos. Duration of storage may be up to an initial 10 years. Once cancer treatment is completed and the all clear is given by the cancer specialist, fertility treatment may be commenced.

Pre-implantation Genetic Testing

Some couples may be unfortunate to have a rare genetic condition that causes significant compromise in quality of health  and requiring lifelong treatment or care needs.

The commonest disease is sickle cell anaemia. In this situation, specilialised testing of embryos created using IVF technology is offered to identify unaffected embryos giving parents a chance for a healthy child.

Oocyte, sperm and embryo donation

Unfortunately, some couples may be faced with childlessness without the chance to be able to have biological children. This includes women with ovarian insufficiency, men where sperm has not been found on surgical retrieval from the testes or in cases of severe genetic conditions. Our team of experts will offer the needed support and professionalism to navigate through the difficult ethical, moral and legal intricacies that comes with gamete donation programme.

Surrogacy

Rarely women may lose the capacity to carry a pregnancy following a hysterectomy or damaged womb lining. In some cases, this is due to the womb not forming from birth. In order to complete a family, surrogacy arrangements are made where the woman’s oocytes are fertilized and an embryo transferred into a gestational surrogate. Legal complexities mean that a clear plan of transfer from the birth mother to the commissioning couple is put in place before starting the process. We are well equipped to help you through this challengig journey.

Endometriosis

Diagnosis of endometriosis

Endometriosis commonly presents with pain, which could be cyclic and related to the menstrual cycle. This may manifest as painful periods, bowel or bladder pain. Pain may also be non-cyclic or continuous. Whereas symptoms may be suggestive of endometriosis, they are often not specific. Examination may reveal pelvic nodules or a mass around the ovary and often areas of tenderness. We perform a detailed ultrasound scan looking for features of endometriosis including a cyst in the ovary, nodules between the bowel and vaginal wall or scarring. Other suggestive signs include areas of discomfort during scanning.

Management of pain

Endometriosis related pain may be amenable to hormone treatment using either the combined contraceptive pill or progesterone only preparations. This may be a sensible option when surgery is not immediately desirable. It is most effective where pain is strongly correlated with the periods. Other medications may include suppressing ovarian hormones to mimic the menopause. Ideally, this option must only be offered where surgery has confirmed endometriosis and symptoms haven’t improved following excision or it is dangerous to excise without damaging vital structures such as nerves or blood vessels. We offer add-back therapy to counteract the symptoms of the menopause that accompany ovarian suppression.

Our specialist may determine that your pain is not responsive to routine hormonal medications and will prescribe other pain modulators such as anti-depressants or centrally acting medications. This is often given in the context of a multidisciplinary team.

Management of Fertility

Most women with endometriosis will have no problems conceiving, however, nearly 50% of women with delayed conception may have endometriosis.
A comprehensive fertility evaluation must be completed to determine the probable cause of delay in conception. This includes confirmation of ovulation, semen analysis and tubal patency testing. Where endometriosis is suspected, performing laparoscopy to ascertain tubal patency provides the unique chance to treat the disease and release adhesions that may hold the fallopian tubes down. There is good evidence to show that laparoscopic treatment of endometriosis increases the odds of achieving a pregnancy. This includes excision of ovarian endometrioma. Care is taken to reduce the inadvertent risk of ovarian damage when the cyst wall is excised.

Where the chance of natural conception is less likely, the option of assisted reproductive treatment offers an opportunity for conception. It is reassuring to note that endometriosis may not necessarily compromise the chance of a live birth with this option.

Where ovarian failure complicates endometriosis, pregnancy may be achieved by use of donor oocytes

Endometriosis Surgery

The most beneficial surgical treatment for endometriosis is excision preferably performed during the first surgery. It requires expertise and experience in complex laparoscopic surgery as disease may involve the bowel, ureters, bladder or the recto-vaginal space. Laparoscopic surgery has the benefit of shorter hospital stay, earlier return to normal activities, reduced complication rates and better visualisation for the operating team. Pre-operative planning and appropriate imaging guides and prepares the patient and surgical team of the expectations during surgery.

The multidisciplinary team

Endometriosis is a complex condition that may have effects in more than one symptom presentation. Due to its chronic nature, the effect on quality of life is often significant with impact on psychological well-being, social relations and occupational disruption. This is worsened by poor understanding of endometriosis amongst the general public. Whereas the gynaecologist is likely the first point of contact with health care, a coordinated multidisciplinary team sets the goals of care for the patient. At FED, we have a fertility specialist also doubling as endometriosis specialist which brings the advantage of a balanced professional able to navigate through the patient journey prioritizing care goals.

Endometriosis Research

Whereas endometriosis has gained significant attention in the recent past, there remains a lot of work to be done to understand the disease and develop innovative treatments. We have various ongoing research projects whose success has depended on the willingness of our patients to participate and the great partnership of our collaborators. We remain indebted to you all. To take part in any of our research projects, please contact Dr Charles Muteshi for further details.

FIND US HERE

Aga Khan University Hospital,
3 rd Parklands Avenue,
Parklands, Nairobi,
Kenya.

[/vc_column]