Fertility & Endometriosis | Fertility Out Loud

Fertility & Endometriosis

By Takera Mitchell, RN, BSN, Fertility Coach & Connie Stark, RNC, C.P.C., Fertility Coach

What is endometriosis?

Endometriosis is a medical condition where the tissue that normally grows in the uterus is found outside of this area. Bits of the uterine lining called the endometrium (or similar tissue) grow on other pelvic and reproductive organs, including the ovaries. When endometriosis involves the ovaries, cysts known as endometriomas may form. The surrounding tissue can become irritated, eventually developing scar tissue and adhesions. This out-of-place tissue can lead to various degrees of pain, sometimes severe, especially during menstrual periods. It can also lead to fertility issues. 

According to the American Society for Reproductive Medicine (ASRM), up to 10% of all females may have endometriosis. Some who have endometriosis experience few or no symptoms, some experience severe menstrual cramps, chronic pelvic pain, or painful intercourse, and in others, infertility may be the only symptom. 

5 signs it’s time to discuss endometriosis with your OBGYN

Here are 5 things to look out for that indicate you should talk to your OBGYN about the possibility of endometriosis:

  1. Severe, debilitating abdominal cramps (preventing regular activity)
  2. Pelvic pain, usually worse during a period (with no or minimal relief)
  3. Long and heavy periods (more than 7 days)
  4. Discomfort during or after sexual intercourse
  5. Painful bowel movements or urination during menstruation 

Challenges with diagnosing endometriosis

Diagnosing endometriosis can be challenging because the symptoms are nonspecific, systemic, and associated with other disorders. Many women suffer for years as symptoms are often dismissed as “normal” and period-like. These symptoms may appear to be issues with going to the bathroom (bowel and bladder), in addition to abnormalities with the menstrual cycle. 

Does endometriosis cause infertility?

Infertility is a concern with endometriosis. Many women with endometriosis have pelvic or abdominal pain, particularly with menstrual bleeding or sex. Irregular and painful menstrual cycles can impact the ability to get pregnant, physically and emotionally. It can also impair the ability to get pregnant from a structural standpoint, if the endometriosis causes any obstruction preventing an egg from meeting sperm.

It can affect fertility in several ways, including: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality. 

When it comes to endometriosis and infertility, the severity of the disease may impact the ability to get pregnant. Severe endometriosis would generally be associated with lower pregnancy rates, as well as the increased need for assisted reproductive technology (ART). 

Endometriosis treatment

General endometriosis treatment:

There are varying stages of endometriosis ranging from 1 to 4, depending on the severity of symptoms and pain. Your healthcare provider will discuss the best treatment option for you, but some treatment options include over-the-counter medication or even surgery.

The medication route typically involves birth control pills or other drugs that lower or block estrogen. This form of medical treatment may help improve pain symptoms, but won’t necessarily help in trying to conceive.

The surgical treatment option, which can help with trying to conceive, is known as “laparoscopy.” Laparoscopic surgery is a standard treatment for endometriosis and is minimally invasive. It allows your doctor to see and remove any necessary tissue and adhesions. When going through the surgery, your doctor typically evaluates the amount (of tissue and adhesions), location, and depth of endometriosis and gives you a score, which determines whether your endometriosis is considered minimal (Stage 1), mild (Stage 2), moderate (Stage 3), or severe (Stage 4). The scoring system can help understand the likelihood of pregnancy success. Women with severe (Stage 4) endometriosis, which causes considerable scarring, blocked fallopian tubes, and damaged ovaries, experience the most difficulty becoming pregnant and often require advanced fertility treatment, like in vitro fertilization (IVF).

In severe cases of endometriosis, a hysterectomy may also be considered, typically as a last resort when there is no significant response to medical or surgical intervention. If a hysterectomy is the chosen route of treatment, it is ideal to pursue fertility preservation before for those who desire to conceive.   

Interestingly, pregnancy is sometimes an excellent treatment for endometriosis, as the symptoms can diminish with the absence of menstrual cycles. This sounds like an ideal solution for those who want to conceive, though the condition can present difficulties. 

Fertility treatment:

As mentioned previously, the effect of endometriosis on fertility varies depending on stage (or severity). And therefore, the fertility treatment options will also vary and will likely take into consideration other factors such as age and length of infertility. 

Those with infertility associated with mild to moderate endometriosis (up to Stage 3) will often be treated with what’s known as “controlled ovarian hyperstimulation” (a process that uses medication to stimulate the development of multiple mature follicles and eggs) paired with timed ovulation and intrauterine insemination (IUI). 

Those with infertility associated with severe endometriosis will often be treated with the “next level” of fertility treatment, IVF, in an attempt to improve pregnancy success rates. 

Reducing your risk

Endometriosis cannot be prevented; however, the risk may be reduced with the following interventions. Diet can play an important role in reducing the risk of endometriosis. Consuming green vegetables and fresh fruits may be the most beneficial, as they contain important antioxidants. Another important factor in reducing the risk of primary endometriosis is the maintenance of a healthy lifestyle, which includes regular rest, movement, and physical activity.  

The earlier, the better

In summary, early recognition of endometriosis and validation of symptoms can alleviate suffering and lead to quicker treatment and better management. Endometriosis that is left untreated can lead to infertility, but there are treatment options for endometriosis-related infertility. Early diagnosis and intervention are imperative to support reproductive health. If you think you may have endometriosis, seek care with an OBGYN or fertility specialist (reproductive endocrinologist)!

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