How Does Endometriosis Impact Fertility?

Endometriosis is a complex and often misunderstood condition that affects millions of women worldwide. It can cause a wide range of symptoms, including pelvic pain, irregular periods, and infertility. For couples trying to get pregnant, it’s important to understand the relationship between endometriosis and fertility.

What Is Endometriosis?

Endometriosis is a chronic condition in which the tissue that lines the inside of your uterus (the endometrium) grows outside the uterus. It can grow on your ovaries, fallopian tubes, bladder, intestines, and other areas throughout your pelvis. Unlike the lining of your uterus, which sheds during menstruation, the tissue growing outside the uterus remains since it has no way to exit the body.This can lead to inflammation, scarring, and the formation of adhesions.

The exact cause of endometriosis is unknown, but there are several theories that may explain it. One common theory is retrograde menstruation, where menstrual blood flows backward through the fallopian tubes and into the pelvis instead of exiting the body. Other possible causes include hormonal imbalances, a genetic predisposition, and environmental factors or a combination of any of these.

The symptoms of endometriosis can vary from person to person and range in severity from mild to severe.

Common endometriosis symptoms include:

• ‍Pelvic pain: This is the most common symptom of endometriosis and is usually worse during menstruation. You may also experience pain during sex, bowel movements, or urination.‍
• Menstrual irregularities: People with endometriosis may experience heavy, very long, or irregular periods. Spotting between periods is also common.‍
• Painful intercourse (dyspareunia): Endometrial growths and scar tissue can cause discomfort or pain during sex.‍
• Gastrointestinal symptoms: If you have scarring or adhesions on your intestines, this can lead to symptoms such as bloating, constipation, diarrhea, or abdominal cramping. This can often be mistaken for irritable bowel syndrome (IBS).‍
• Infertility: Endometriosis is a leading cause of infertility in women, affecting up to 30-50% of women seeking fertility treatment.

Diagnosing endometriosis can be difficult because having the symptoms does not necessarily mean you have it. A confirmed diagnosis requires a thorough review of your medical history, a pelvic examination, imaging (such as ultrasound or MRI), and minimally invasive procedures like laparoscopy to confirm and biopsy any abnormal tissue growth.

Impact of Endometriosis on Fertility

Endometriosis can make it challenging to conceive without the help of fertility treatments. While not everyone with endometriosis will experience infertility, the severity of symptoms and the extent of the disease can impact your chances of becoming pregnant.

Endometriosis can cause a range of issues that can hinder conception, including:

Structural Changes

Endometriosis can cause tissues and organs in your pelvis to stick together. This can affect how your organs function, including reproductive organs like the ovaries, fallopian tubes, and uterus. This can cause problems with ovulation, fertilization, and embryo implantation, making it harder to conceive.

Hormone Imbalances and Ovulation Issues

Endometriosis can be associated with hormonal imbalances, which can result in abnormal ovulation. Because of this, the ovaries may not be able to release or produce mature eggs for fertilization after your period is over, which means you have less chances of becoming pregnant. Hormonal changes can also disrupt the normal menstrual cycle and make the uterine lining inhospitable for embryo implantation.

Inflammation and Immune System Issues

The chronic inflammation that comes with endometriosis can affect egg quality, sperm movement, and the embryo’s implantation into the uterus. Immune system issues are also associated with endometriosis and can contribute to infertility by causing the body to attack sperm, eggs, or embryos as foreign invaders.

The severity of endometriosis doesn't always match up with fertility challenges. Some people with mild cases of endometriosis struggle to conceive, while others with severe endometriosis might conceive without any difficulty. Additionally, having endometriosis does not necessarily mean you cannot get pregnant, and many people with the condition can conceive and build their families with the support of a fertility specialist.

How is Endometriosis-Related Infertility Treated?

Despite the challenges, there are several paths to improving fertility for those with endometriosis:

Surgery

To remove tissue growths and improve fertility, doctors may recommend surgery, often through a less invasive method called laparoscopy. This treatment can improve fertility by restoring the normal function of any organs impacted by endometrial growths or adhesions and reducing inflammation.

Hormonal Therapies

Your provider may recommend hormonal medications as a treatment, which can help by stopping the growth of tissue outside of the uterus. Hormonal therapies may be used alone or with other treatments.

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a commonly used fertility treatment in which doctors will retrieve a person’s eggs from their ovaries, fertilize them with sperm in a laboratory setting, and transfer the resulting embryos into the uterus of the person wishing to become pregnant. Since IVF bypasses the need for normal ovulation or for the egg to make the journey from the ovaries to the uterus, it can be helpful for people experiencing infertility. Additionally, IVF allows doctors to select the healthiest embryos for your pregnancy, maximizing the likelihood of success.

Fertility Preservation

For people with severe endometriosis that requires surgery or aggressive medical treatments that could negatively impact the ovaries, fertility preservation can be invaluable. Fertility preservation options include egg freezing or embryo freezing before starting your treatment. This allows an individual to preserve their eggs so that they can build their families later in life without worrying about the impact of time or medical treatments on their reproductive ability.

Donor Eggs

In cases where endometriosis has affected a person’s egg quality or quantity, donor eggs with IVF can be used to achieve pregnancy. In this treatment, eggs from a donor are fertilized with either a partner’s sperm or donor sperm. The resulting embryo is then transferred to the intended parent’s uterus, where it grows and develops like any other pregnancy.

Gestational Surrogacy

In cases where endometriosis or other factors make pregnancy unsafe or unfeasible, gestational surrogacy can offer a path to parenthood. Gestational surrogacy involves using a surrogate to carry a pregnancy on behalf of those who are unable to carry a pregnancy themselves. During gestational surrogacy, embryos created through IVF using the intended parents' eggs and sperm are transferred into the surrogate's uterus, and the surrogate carries the pregnancy to term.

Lifestyle Changes

Lifestyle changes can support your overall reproductive health and improve fertility for people with endometriosis. These include:

• Maintaining a healthy weight through a balanced diet and regular exercise.
• Managing stress through relaxation techniques such as yoga, meditation, or counseling.
• Avoiding harmful habits such as smoking, excessive alcohol consumption, and drug use; this can impair fertility and exacerbate symptoms of endometriosis. 

Endometriosis has a complex array of symptoms and can have a significant impact on your reproductive system. However, with advancements in fertility care and a comprehensive approach to treatment, there is hope for those navigating endometriosis-related infertility. 

People with endometriosis who are looking to start a family should work closely with a fertility specialist to develop a personalized treatment plan tailored to their individual needs and family goals. By empowering yourself with knowledge and exploring your options, you can increase your chances of fulfilling your dreams of building a family. If you’re looking for personalized guidance and expert support in navigating endometriosis-related infertility, connect with our team of fertility specialists and schedule a consultation today.

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