Endometriosis and infertility: what you need to know

Endometriosis can occur at any site. It can be present inside the abdomen or extra-abdominal sites.

Common sites are :

1. Ovaries

2. Fallopian tubes

3. Pouch of Doughlas

4. Pelvic lymph nodes

5. Peritoneum

6. Sigmoid colon

7. Appendix

8. Abdominal scar.

Rare sites : brain , lungs , kidney, ureter etc.

Most common symptom in endometriosis is lower abdominal pain radiating to thighs and back. It can present before/during menstruation , before / during ovulation , before/ during sexual intercourse , while passing stools , while passing urine etc.

Is endometriosis a cause of infertility?

Endometriosis is a progressive condition, meaning it can gradually worsen over time. As endometriosis patches grow in the pelvic and abdominal areas, they can block the reproductive organs. As a result, sperm have a harder time reaching the egg.

It is also possible for these growths to damage the reproductive organs, preventing them from functioning properly.

Endometriosis can also affect fertility by

1. Preventing the implanting of an embryo

2. Scarring of the fallopian tubes

3. Affecting the growth of eggs

4. Inducing hormonal imbalances

5. Chronic pelvic inflammation

Types of endometriosis and fertility

There are three types of endometriosis: superficial peritoneal, endometriomas, and deep infiltrating. A person's body is classified according to the location of the endometriosis patches.

A person can have one or multiple types. Additionally, medical professionals divide endometriosis into stages. They range from I–IV, with stage I being the least severe and stage IV the most severe.

Superficial peritoneal

The peritoneum is a thin film lining the abdomen. When a person has a peritoneal lesion, they may have growths or cysts in the peritoneum.

Doctors usually class superficial peritoneal lesions as stage I or II endometriosis. Despite superficial peritoneal lesion being the least severe form of endometriosis, some people may find conceiving difficult.

Endometriomas

Endometriomas are cysts that grow on the surface of or inside the ovaries. They are dark, fluid-filled sacs that doctors sometimes refer to as chocolate cysts.

When a person has endometrioma, they usually have stage III or IV endometriosis.

Endometriomas can greatly impact a person’s fertility due to their damaging effect on ovarian tissue, which may lead to ovulation issues.

Deeply infiltrating

In deeply infiltrating endometriosis, endometrial-like tissue grows on organs near the uterus, such as the vagina, bladder, and bowel. It is the most severe form of the condition.

Doctors usually classify deeply infiltrating endometriosis as stage IV because a person has growths or lesions that extend 5mm below Trusted Source the peritoneum.

In addition to endometriomas, a person with stage IV endometriosis may have extensive scarring in the ovaries, uterus, and rectum.

If a person has already undergone previous cyst removal surgeries, they may have also lost a significant number of eggs.

It is important to note that while a person may no longer be able to conceive naturally at this stage, they may become pregnant with IVF treatment.

The endometriosis fertility index

If a person with endometriosis wants to conceive, a doctor may evaluate their condition using the endometriosis fertility index (EFI).

The EFI is a 10-point scale that can tell a doctor how likely a person is to get pregnant without medical intervention. The scale considers factors including Trusted Source

● Age

● Endometriosis stage

● Least function score (measures fallopian tube and ovarian function)

● Length of infertility

● Medical history

● Prior pregnancies

A person’s score can predict their likelihood of getting pregnant, and it can help individuals and doctors make the best decisions for their fertility.

Although recommendations vary from person to person, a 2021 study Trusted Source concluded that people with scores of 5 or higher might be able to try conceiving naturally for 24 months before medical intervention. The authors said that those with scores of 4 or lower should be referred for artificial reproductive treatments more quickly.

Endometriosis fertility treatment options

If you have not become pregnant after trying for 6–12 months with endometriosis, there are several treatment options available.

Depending on the type and stage of endometriosis, a doctor will recommend a treatment.

Stages I-II treatments

An individual with early endometriosis might be able to get pregnant without medical assistance.

A doctor may advice IUI or an IVF procedure or laparoscopy , if a woman has difficulty conceiving, depending on other factors.

This is a simple procedure where a medical professional inserts a camera through a small incision in the stomach. A doctor can use this to assess how many lesions a person has and surgically remove them if necessary.

For people who are 35 or older, doctors may recommend intrauterine insemination (IUI) instead of surgery.

If this treatment is unsuccessful, a doctor may suggest injectable fertility medications or IVF.

Treatments for stages III–IV

In the later stages of endometriosis, a doctor will likely recommend IVF.Recent recommendation for grade 3 / 4 endometriosis is IVF - downregulated frozen embryo transfer.

Support for endometriosis and infertility

Endometriosis is a painful, progressive condition that can be difficult to cope with. People struggling to get pregnant with the condition may feel isolated and discouraged, especially if they have been trying for a number of years without success.

Summary

Endometriosis is a condition where endometrial-like tissue grows outside the uterus. It can impact a person’s fertility, making it harder to get pregnant.

People in the early stages of the disease may be able to conceive without medical assistance, but they are likely to need medication, IUI, or IVF in the later stages.

Living with endometriosis can be difficult, and support groups and resources can help those who are struggling.