Endometriosis & Infertility

Endometriosis is the condition when endometrial tissue is found outside the uterine cavity, maybe in the ovaries and tubes and at times even on the gall bladder or intestines. This tissue may irritate structures that it touches, causes pain and even adhesions to the surrounding organs.

How to tell if someone has endometriosis?

Many women with endometriosis experience pelvic or abdominal pain, particularly during menstrual bleeding or during sex or intercourse. Some women have no symptoms. This condition can make it difficult for women to get pregnant. In fact, it is seen that around 30% to 50% of women with infertility issues have endometriosis. Sometimes, endometriosis grows inside the ovary and form a cyst (endometrioma). This cyst can be seen on ultrasound, unlike any other endometriotic tissue.  The ultimate confirmatory diagnosis of endometriosis is done by diagnostic laparoscopy and interventions can be taken in the sale sitting. MRI may be raised in endometriosis. 

Does endometriosis cause infertility?

Almost 30% to 50% of women with endometriosis may experience issues of infertility. Endometriosis can impact fertility in many ways such as altered immune system functioning, adhesions, distorted anatomy of the pelvis, inflammation of the pelvic structures, scarred fallopian tubes, altered egg quality, impaired implantation of pregnancy, and changes in the hormonal environment of the eggs.

To evaluate the severity of endometriosis, at the time of surgery the doctor may evaluate the amount, location, and depth of endometriosis. Women with severe endometriosis, experience struggle, causing considerable scarring, blocked fallopian tubes, damaged ovaries face the most difficulty in becoming pregnant and require advanced fertility treatment.

Treatment of endometriosis?

Generally, the patient visits the doctor for treatment of endometriosis for pain and infertility.   Endometriosis requires the female hormone estrogen to grow. The usage of birth control pills and many other drugs that down-regulate or block the estrogen is seen to be effective in improving pain-related symptoms. However, for patients who are planning for pregnancy, medical therapy can be taken prior to attempts at conception. But, another point to be noted here is that the treatment marginally improves pregnancy rates.

During a diagnostic laparoscopy, endometriotic spots can be removed, endometriotic cystectomy can be done, adhesions can be removed, rectovaginal nodules can also be removed. The surgical intervention restores normal anatomy and allows the reproductive organs to function in a normal manner. In fact, post this surgical treatment, chances of becoming pregnant gets improved, especially if the endometriosis is in a moderate or severe range. At times, the combination of surgical and medical therapy can also be beneficial for patients trying to conceive through IVF. Overall, the treatment should be individualized for each patient.