Endometriosis and Female Infertility

Endometriosis at a glance

  • Endometriosis, a common cause of infertility, is the spread of tissue that normally lines the uterus to the outside of the uterus.
  • Although many women can have endometriosis but not experience symptoms, the most common symptom is pelvic pain.
  • Infertility is also considered a potential symptom, but women with endometriosis often become pregnant after treatment.
  • Possible treatment options are lifestyle changes, medication, and surgery.

How does endometriosis affect infertility?

Endometriosis, a common cause of female infertility, is a problem many women have during childbearing years. Endometriosis is the spread of tissue that normally lines the uterus to the outside of the uterus, sometimes causing infertility, abdominal discomfort or even severe pain.

It usually is not dangerous, but it is a progressive disease and should be treated, and it can be quite painful. The invading tissue from the endometrium may attach itself and grow upon any organ or structure within a woman’s pelvis, including the ovaries, which can lead to removal of one or both ovaries. Experts do not know why some women develop endometriosis.

Endometriosis is found in 35- 75 percent of infertile women with no other diagnosed problem, according to the American Society for Reproductive Medicine (ASRM). Although many theories attempt to explain why it is harder for women with endometriosis to conceive, endometriosis is not completely understood. However, many women with endometriosis become pregnant after treatment.

Although many theories have been proposed to explain how endometriosis is related to infertility, it is not completely understood. Generally it seems to mimic an inflammation, like and infection. The implants of endometriosis secrete factors which can interfere with eggs, sperm and embryos in animals. It is believed that humans experience similar effects.

Prevalence of endometriosis in the general population is unknown because many women can have endometriosis but not experience symptoms. Studies have estimated that approximately 5 percent of all women undergoing surgery for any gynecologic conditions have endometriosis. In those women undergoing surgery for pelvic pain, 12 to 32 percent have lesions, and in women having surgery for infertility, 21 to 48 percent have endometriosis.

Although many women with endometriosis are completely asymptomatic, the most common symptom is pelvic pain which is more severe during menses. The characteristic symptoms include painful menstrual periods, abnormal menstrual bleeding and pain during or after sexual intercourse.

Infertility is also considered a potential symptom, and in some cases endometriosis is not discovered until a woman is examined and tested for infertility.

Having endometriosis does not automatically mean that that a woman will never have children without difficulty. However, it may be harder for women with endometriosis to become pregnant. Endometriosis is a relative barrier, not a brick wall.

How is endometriosis treated?

After a medical history review and pelvic exam, an outpatient surgical procedure called a laparoscopy is necessary to confirm a diagnosis of endometriosis. With surgery, the disease is treated with lasers or electric current, which improve the odds of successful pregnancy.

Possible treatment options are lifestyle changes, medication for both pain and hormonal regulation, and surgery. A physician’s advice on treatment is critical after a woman’s level of endometriosis has been diagnosed.

Women with infertility caused by endometriosis may first try surgery, tincture of time and insemination treatment. If these are not successful but the woman want to have biological children of her own, the use of assisted reproductive technologies such as in vitro fertilization (IVF) may be considered. Some couples with long term infertility or in older age groups may elect to ignore the possibility of endometriosis and skip the laparoscopy, moving to IVF right away, which bypasses the effect of endometriosis.