How endometriosis can affect your fertility
Endometriosis is a disease that occurs when tissue similar to the lining of the womb (endometrium) implants outside the womb and continues to grow. It can be found on the ovaries, bowel and even in the lungs. Endometriosis affects about 10 to 15 per cent of women of the reproductive age group. Of the women with endometriosis 30 to 50 per cent may have trouble getting pregnant.
Infertility is the inability to get pregnant after one year of having regular unprotected intercourse. Endometriosis can cause infertility in a number of ways and this largely depends on the stage of the disease. Mild endometriosis is less likely to prevent pregnancy but it can cause inflammation, which can later impair ovarian and endometrial function, thus reducing implantation, which is the attachment of the embryo in the womb. Women who do not have scarring from endometriosis can therefore still have problems getting pregnant.
Severe endometriosis causes scarring. It behaves almost like “glue” and causes structures in the body to stick together and distort the normal anatomy. This can lead to blocked fallopian tubes which prevents the natural process of conception. The fallopian tubes collect the egg released from the ovary and holds it until it is fertilised by a sperm. The process of fertilisation therefore first occurs in the fallopian tubes, and the resulting embryo then migrates to attach or implant in the uterus. Blocked fallopian tubes will therefore lead to infertility.
Severe endometriosis also negatively affects the ovary and the fertilisation of potential eggs. It also affects egg quality. In some cases, the endometriosis deposits will form a cyst in the ovary, called an endometrioma. This cyst, also called the “chocolate cyst”, contains a thick brown tar like fluid. The presence of an endometrioma, which can be identified on ultrasound, usually indicates that you have severe disease. Endometriomas cause damage to the ovary and can reduce the number of eggs in your ovaries. There is no evidence that small endometriomas affects pregnancy rates however, and as such endometriomas smaller than four centimetres are not surgically removed to improve fertility. In fact, surgery on the ovary may reduce the total number of eggs in the ovary.
What can you do?
It is important to get diagnosed early so treatment can be implemented. Sadly, it takes about seven to 10 years from the onset of the disease before endometriosis is usually diagnosed. However, if you see your doctor early this can be reduced.
What are the symptoms?
*Some women with endometriosis have no symptoms, but classic endometriosis symptoms include:
*Painful periods, especially if the pain is so severe that it stops you from going to work or school
*Painful intercourse — sex should not be painful
*Pain before the onset of the menses, or right after the menses finishes
*Pain with bowel movements and while urinating, especially during the period
Patients with severe disease can have mild symptoms, while those with mild disease can have severe symptoms.
Implement treatment early
Medical management — done primarily to control the symptoms. These include anti-inflammatory tablets, hormonal suppression (such as oral contraceptive pills, and other medications).
The gold standard of diagnosis and treatment is laparoscopic surgery. The goal of surgery is to remove the endometriosis deposits and scar tissue. Surgery is thus a good option for patients with localised pain, failed medical management and those not getting pregnant.
Fertility treatment
There are several options for treating infertility in women with endometriosis:
1.Fertility drugs to stimulate the release of more than one egg, thus increasing the chance of pregnancy
2.Intrauterine insemination (IUI)
3.In vitro fertilisation (IVF).
Early detection and treatment is the key.
Dr Michelle Bailey is a Consultant ObGyn, fertility specialist and laparoscopic surgeon at Gynae360.
