Endometriosis and Fertility

Endometriosis is said to affect 1 in 10 women during their reproductive years. Perhaps you are one of them. Effects of endometriosis can include painful periods, painful ovulation, pain during and after sexual intercourse, heavy menstrual bleeding, chronic pelvic pain, fatigue, and infertility. [R] This impacts your physical well-being and can impact your emotional health as well.  

What is Endometriosis

Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”) is found outside the uterus. The condition induces a chronic inflammatory reaction that may result in scar tissue.  [R[ 

Symptoms

Endometriosis symptoms can include pain before and during periods, pain in between periods, pain during or after sex, pain when urinating or having a bowel movement (often during monthly periods), difficulty achieving pregnancy, and cysts of endometriosis on the ovaries called endometriomas, also sometimes called chocolate cysts.  [R] Other symptoms may include heavy bleeding during menstruation and fatigue. [R[  Some of the symptoms have been “normalized” to be associated with menstruation in general, and therefore, there seems to be an average delay of seven years between the onset of symptoms and a woman seeking treatment. [R] 

Cause

There is no known cause of endometriosis, but it appears to be related to complex interactions of immunologic, hormonal, environmental, and genetic factors. [R]  Women have a higher risk of developing endometriosis if their mother and/or sister(s) are also affected. Gynecological factors such as age when the menstrual period starts, prolonged menstrual flow, and short cycle interval may be possible risk factors. [R] There is some evidence environmental factors such as exposures to toxins such as dioxin (an environmental pollutant) and PCBs can correlate to endometriosis symptoms. [R]

Treatment

While there is currently no cure for endometriosis, there are treatments available. Pain medications may alleviate discomfort symptoms, although they do not address other symptoms such as heavy bleeding, fatigue, or infertility. Birth control pills may also be an option in reducing pain symptoms, though this is not an option for treatment if you are trying to conceive. Additionally, some women may not want to be on a hormone-based medication for an extended period of time. Doctors may also recommend surgery such as laparoscopy to remove endometriosis tissue or a hysterectomy depending on the severity of symptoms [R]

Treatment options are considered in relation to the patient’s age, desire for children, the severity of symptoms, and the endometriosis stage and should be discussed with your provider. 

How Does Endometriosis Affect Fertility

Having a diagnosis of endometriosis does not automatically mean a woman will experience infertility; some women can achieve pregnancy without difficulty. Women who have endometriosis may experience difficulty in achieving pregnancy.  Studies show endometriosis is the cause of up to 50% of infertility cases. [R] The excess tissue growth may cause adhesions, scarred fallopian tubes, or inflammation of the pelvic structures. 

Because endometriosis may be caused by an excess of estrogen in the system, some women may also experience altered immune system functioning, changes in the eggs’ hormonal environment, impaired implantation of a pregnancy, and altered egg quality as a result of the hormonal imbalance. [R]

Endometriosis and IVF

Assisted reproductive technology is the first line of treatment in patients who experience infertility due to endometriosis. [R]  Studies seem to indicate that treatment’s success depends on individual patient factors play the most crucial role in the outcome. Treatment choice depends on the patient’s age, duration of infertility, disease level of progression, and childbearing wish. [R]
Integrative medicine may also provide support with pain management and stress during the IVF process for all patients, not just those with endometriosis. Yoga and acupuncture are two ways patients can manage pain and stress levels. A clean diet and lifestyle also promote healthier estrogen levels, which may support efforts in alleviating some symptoms of endometriosis. 

If have endometriosis and would like to explore treatment options, contact our clinic for an appointment.