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

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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Chapters

• 0:00 Quick Connect Introduction
• 0:47 Meet Dr. Naomi Whitaker
• 1:26 Understanding Adenomyosis Types
• 3:22 Why Surgeon Choice Matters
• 5:25 Episode Wrap-up

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: 0:47

I'm joined at the table today by Dr Naomi Whitaker, 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 into this. Are you able to speak on the success rate for those patients 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 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: 1:55

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. 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 an enlarged 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 technologies 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: 3:06

I see it frequently and I don't see other signs of issues. If it's just that, for example, right and I don't, 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. 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.

Speaker 1: 3:46

Now it's definitely trickier surgically 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 to do this, no matter what Period.

Speaker 2: 4:02

If you are interested in fertility and I think that's something I really want to bring out today into light is that who your surgeon is matters more than anything. Right, Because not only finding it all, but tissue handling being very delicate with tissue I see people on social media even just grabbing 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. 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.

Speaker 2: 4:33

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. Path was negative for endometriosis on the tube. They took out the whole tube. So surgeon choice matter. There's someone who's fertility friendly, who really respects that, and so it's. There's a lot to it. We could definitely go into it more. That's touching the surface of it, but number one respecting autonomy. Respecting that. You know I have patients all the time.

Speaker 2: 5:04

Are you going to take out my tube? Are you going to take out my ovary? I mean, you know and I explain how often I do that, which is almost never, unless I think it looks like there's a cancer I pretty much try to save every fallopian tube or ovary. After you know, informed discussion with a patient, of course, yeah, I'm sure there are exceptions in women who aren't trying to. I'm talking about trying to conceive population.

Speaker 1: 5:25

Yeah, 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 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.