Speaker
Renato Tomioka
Appearances over time
1 episodes
Episodes
1
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Quotes & moments
Endometriosis affects approximately 10% of reproductive-aged women, equating to roughly 200 million women globally.
Among women struggling with infertility, 30 to 50% have endometriosis, and if a woman has endometriosis, she faces roughly a 40% chance of being infertile.
Modern women experience roughly four times as many ovulatory cycles as women 200 years ago, likely driving rising endometriosis prevalence.
Women with endometriosis wait an average of 5 to 12 years from first symptom to diagnosis, with about 6 years in the US and 7 years in Brazil.
Endometriosis costs an estimated $80 to $120 billion per year globally, with two-thirds of that attributable to productivity loss rather than direct medical costs.
Adenomyosis may be even more prevalent than endometriosis, affecting up to 20–30% of women, yet it remains underdiagnosed and underappreciated.
Up to 70% of women with endometriosis may also have some degree of adenomyosis, a comorbidity with major implications for fertility treatment.
Adenomyosis reduces the chances of successful IVF by approximately 30%, with junctional zone involvement tripling miscarriage risk.
Specialized MRI and dedicated endometriosis ultrasound protocols achieve sensitivity of about 95–98% for detecting endometriosis, making diagnostic laparoscopy largely obsolete.
Inserting a Mirena IUD after endometriosis surgery reduces recurrence rates by 88% compared to placebo, highlighting the importance of post-surgical hormonal suppression.
The NIH invests approximately 15 times more money on diabetes research than on endometriosis research, despite endometriosis costing more per patient per year.
At ages 31 to 34, approximately one-third of blastocysts are aneuploid; the rate climbs to 40% by 35, 60% by 38, and over 80% by age 42.
Only about 10% of women who electively freeze their eggs ever return to use them, raising important questions about the cost-effectiveness and timing of egg freezing.
Despite biological arguments for freezing at 25, cost-effectiveness analysis suggests the optimal age for elective egg freezing is around 32 to 35.
Among teenagers presenting with pelvic pain, up to 50 to 75% are found to have endometriosis, illustrating how early the disease can manifest.
Endometriosis pain has three layers: lesion pain, nerve infiltration, and central sensitization. Once the nervous system has been on high alert for years, even a flawless surgery leaves the alarm ringing. Surgery removes the burglar, hormones lock the door — but the wiring is already changed.
At 31, roughly one-third of blastocysts are chromosomally abnormal. By 38, it's 60%. By 42, more than 80%. The curve is not linear — it accelerates. Most doctors don't show patients this table, but every woman thinking about timing her family should.
Endometriosis presents as a constellation of six types of pain and dysfunction — the six Ds. Each one is often dismissed as normal, and together they explain why women suffer for an average of 6 years before diagnosis. Knowing the pattern is the first step to demanding a workup.
Three factors combine to delay endometriosis diagnosis by 5 to 12 years: cultural normalization of female pain, the absence of a blood biomarker, and historic reliance on surgical laparoscopy for confirmation. High-sensitivity MRI and expert ultrasound are making the surgery-first model obsolete.
The aneuploidy rate follows a J-curve, not a straight line. Very young women (under 22) have higher aneuploidy than 25-year-olds due to monosomy. Peak egg quality hits around 25. This isn't coincidence — evolution appears to have optimized for 25-year-old mothers.
Endometrioma cysts are pseudo-cysts tightly adhered to ovarian cortex where primordial follicles live. Strip them out and you can reduce AMH by 40 to 50%. Leave them in and the Fenton reaction destroys follicles through hydroxyl radical toxicity. The right move: harvest eggs first, then decide on surgery.
Only about 10% of women who electively freeze eggs ever return to use them. Most get pregnant naturally. The cost-effectiveness sweet spot is around 32 to 35, not 25, because the biological advantage of younger eggs is offset by the high probability they're never needed. Freezing at 25 makes biological sense; freezing at 32–35 makes financial sense.
If pluripotent stem cells can be reliably converted into functional, chromosomally normal eggs, age becomes irrelevant to fertility. It has been done in mice with normal offspring. Larger animals are next. Renato Tomioka estimates 10 years to clinical reality — and when it arrives, egg freezing becomes obsolete.
At 40, a typical stimulated cycle yields around 8 eggs. After maturity rates, fertilization, development to blastocyst, and aneuploidy screening, you may be left with one or zero usable embryos. IVF isn't a guarantee — it's a multiplication of small probabilities that gets harder with every passing year.
Two hundred years ago women had roughly 100 lifetime ovulatory cycles; today the number is closer to 400. Later menarche, earlier menarche now, fewer pregnancies, less breastfeeding — the modern reproductive pattern was never anticipated by evolution, and endometriosis prevalence is rising as a result.
In deep infiltrating endometriosis and adenomyosis, up to 37% of lesions carry the same oncogenic mutations (KRAS, PIK3CA) that drive cancer growth. But fibrosis traps them. It is, biologically, a 1,000-horsepower engine inside a golf cart.
Without post-surgical hormonal suppression, endometriosis recurs at roughly 10% per year. A Mirena IUD inserted after surgery cuts that recurrence risk by 88% compared to placebo. Surgery alone is a temporary measure; the disease is chronic and demands a lifetime treatment plan.
A standard transvaginal ultrasound can entirely miss endometriosis. The specialized bowel-prep protocol with expert interpretation achieves 95–98% sensitivity. If you have endometriosis symptoms and a normal ultrasound report, that report means almost nothing.
Women with adenomyosis who fail repeated IVF transfers are often missing one key step: 2 to 4 months of GnRH agonist therapy before the embryo transfer. This chemically suppresses estrogen, quiets adenomyosis-driven uterine contractions, and meaningfully improves live birth rates.
The first IVF baby was born in 1978. Louise Brown is 48. We have no idea what IVF-conceived people look like at 60 or 70. There may be epigenetic effects from fertilization outside the fallopian tube that we simply cannot yet measure. For couples who can conceive naturally, Tomioka still recommends trying.
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