Endometriosis and Infertility: Causes and Treatments

Introduction

Endometriosis can have profound impact on a woman's ability to get pregnant. It is a chronic (long-term) and often painful disorder that affects women mainly in their reproductive age (15-49 years old).

Not all women with endometriosis require treatment to get pregnant. However, those who are affected may take months or even years to conceive, while others may require some form of fertility treatment in order to get pregnant.

Endometriosis and infertility

Hence, being informed about endometriosis, its symptoms, and the available fertility treatment options available can help women to seek medical assistance early, especially if they are planning to get pregnant.

Endometriosis infertility statistics

Approximately 1 in 10 women are affected by endometriosis during their reproductive years. This is equivalent to an estimate of 176 million women around the globe.

Endometriosis is very common amongst women who experience infertility. In fact, studies have shown that between 25 - 50% of women experiencing infertility are diagnosed with endometriosis. Hence, if you are affected by endometriosis, and find yourself having difficulties getting pregnant, do know that you are not alone.

What is endometriosis?

Endometriosis is the condition whereby tissues similar to the lining of the uterus (or endometrium) are found outside the uterus, in places where it should not be growing, such as in the ovaries, fallopian tubes, bladder, or even in the intestines.

The endometrium plays an important role in a woman’s menstrual cycle. They build up and break down every month, leading to the bleeding that occurs during the start of a period.

Since these displaced tissues resemble the endometrium, they also thicken and cause bleeding every month, during the menstrual period. However, as these endometrium-like tissues cannot exit the organs, they become trapped inside the body hence causing the symptoms of pain and infertility.

Can endometriosis cause infertility?

Yes, endometriosis can cause infertility. In fact, infertility is one of the most common symptoms of endometriosis. Endometriosis is associated with increased levels of hormones, chemical signals, and immune regulatory substances which may affect the normal function of the ovaries, fallopian tubes, and the uterus. This in turn disrupts many of the processes that are important for pregnancy to take place, such as ovulation, fertilization, and implantation.

In advanced endometriosis, the structures and functions of the pelvic organs may be impacted. Adhesions, which are bands of tissues similar to scars, may occur. They contribute to the dysfunction of the ovaries, fallopian tubes, and the uterus. All of these processes may contribute to infertility in endometriosis.

What are the causes of endometriosis?

Until now, scientists and doctors have not found the single, definite cause of endometriosis. Several theories have been formulated to explain how endometriosis develops.

The most popular amongst all is the “reverse menstruation” theory. This theory explains that endometriosis is the result of backflow of endometrial cells that were shed off during menstruation that subsequently attaches to the lining of the ovaries and pelvic area and grows.

Another proposed cause of endometriosis is the altered immune functions of the body. Studies have shown that women who develop endometriosis have hyperactive immune cells that trigger the growth and development of endometrial cells in organs outside the uterus. Other studies also mention a genetic predisposition, such that mothers and their daughters were documented to have endometriosis.

Signs and symptoms of endometriosis

endometriosis symptoms
Common endometriosis symptoms may include pain during menstruation, sexual intercourse and infertility.

The common symptoms of endometriosis may include:

  • Pain during menstruation (dysmenorrhea)
  • Pelvic cramping and pain
  • Pain during sexual intercourse
  • Pain during urination or defecation
  • Infertility

If you experience these symptoms, it best to consult with your doctor in order to determine if you are affected by endometriosis.

How is endometriosis diagnosed?

In order to achieve a clear-cut diagnosis of endometriosis, your doctor will perform a biopsy of the specific organ involved (e.g. ovaries, pelvic lining, intestines). In order to perform a biopsy, a laparoscopic surgery is usually done. The tissues that are obtained from the laparoscopic surgery will then be studied under the microscope to confirm the diagnosis of endometriosis.

The doctor may diagnose endometriosis during the laparoscopic surgery by just looking at the appearance of the ovaries, but this method may not always be reliable.

Stages of endometriosis

Endometriosis can be classified to 4 main stages, depending on the location, extent, and severity of the condition. Knowing the stage of your endometriosis can help your doctor to determine the next course of action. The 4 main stages are as below:

Stage 1: Minimal
Stage 2: Mild
Stage 3: Moderate
Stage 4: Severe

Endometriosis infertility treatment

There is currently no definitive cure for endometriosis, but there are a variety of ways that can be done to manage it’s symptoms, which may help improve fertility. Treatment options for infertility in women with endometriosis is highly personalized, depending on several factors including severity of endometriosis, age of the woman affected, extent of current symptoms, medical history, and personal preference.

When it comes to treatment, it would be best to directly speak to your doctor on the best choice for you.

Endometriosis fertility doctor and consultation

Most doctors would perform infertility evaluation before deciding on treatment. Some of the treatment options may include:

Medications

The major function of medications in the treatment of endometriosis is actually to relieve the pain and to suppress the adhesions and distortion of the reproductive organs.

There are currently no clear cut evidence demonstrating improved fertility via usage of medications such as oral contraceptives, progestins, gonadotropin-releasing hormone agonists, or danazol. However, they may help provide more comfort during sexual intercourse to improve outcomes via natural conception.

Surgery

Laparoscopic surgery may be suggested by your doctor. It is basically a keyhole surgery where several small incisions are made, and a lighted telescope is inserted to carry out the surgery. It is the preferred choice of surgery when small adhesions or ovarian cysts are required to be removed.

Under certain conditions, a laparotomy or an open surgery may also be recommended.

However, for women who are planning to get pregnant, hysterectomy or surgery to remove the entire uterus will not be done, as you would not be able to get pregnant after this procedure.

Depending on your condition, surgery may then be followed by natural conception, ovulation induction, intrauterine insemination (IUI), or in vitro fertilization (IVF).

Ovulation induction

Ovulation could be induced by taking medications that will control your hormone cycle and trigger your ovaries to release eggs in a timely manner. Ovulation induction may include medication such as clomiphene citrate. Do consult with your doctor to understand which type of medication would work best for you.

Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is another fertility option that may be recommended by your doctor. IUI is a simple and non-surgical method that is done by inducing ovulation in a timely manner to increase the chances of fertilization.

The difference between IUI and ovulation induction is that for the IUI process, it involves the direct injection of processed and concentrated sperm into the uterus.

In vitro Fertilization (IVF)

Endometriosis infertility treatment

In vitro fertilization (IVF) is another option for women who want to get pregnant after successful treatment for endometriosis. The IVF process involves harvesting your viable eggs and having them fertilized with sperm in the laboratory. The fertilized egg, now known as an embryo, will then be placed into your uterus. The embryo will then develop as a baby inside the uterus during the course of the pregnancy.

IVF has a much higher cost in comparison to IUI, but it also demonstrates much higher success rates.

Long term outlook

Getting pregnant with endometriosis may prove to be more challenging for couples, but that does not mean that it is impossible. In fact, some women are able to conceive naturally without any form treatment.

However, if you are experiencing any of the common signs and symptoms of endometriosis, and have been trying to get pregnant for more than a year but still unsuccessful, it would be recommended to seek up professional help.

If you need help, do get in touch with us and we will help schedule a consultation with a fertility doctor near you.

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