Ask the Experts: How does endometriosis impact fertility?

Getting pregnant when you have endometriosis can be more difficult than usual, but it’s possible. Read on to know more about how this condition impacts your fertility.
myths about endometriosis
There’s a strong link between menstruation and fertility. Image courtesy: Shutterstock
Dr Pallavi Prasad Updated: 12 Apr 2021, 05:19 pm IST
  • 85

The term endometriosis comes from the word ‘endometrium’, which refers to the uterine lining that your body develops each month in preparation for egg implantation. If you do not conceive within a given month, your body will shed the endometrium and you will have your periods. This endometrial tissue will often pass through the fallopian tube and into the abdomen.

The tissue can bind to other organs in some women. Hormones released during the next menstrual cycle cause this extra tissue to develop and then shed, much like the tissue in the uterus. This bleeding and tissue shedding, on the other hand, has no means of leaving the body, causing inflammation of local tissue. The discomfort that patients with endometriosis often feel is usually caused by inflammation.

Signs of endometriosis

Discomfort before and during menses, painful intercourse, infertility, pain or other abnormalities with urination or bowel movements at the time of menses, break through bleeding between menses, and fatigue are all common endometriosis symptoms. However, up to 15-20 percent of women with endometriosis may have no symptoms. Some immune disorders, such as asthma, eczema, and fibromyalgia, may be present in women with endometriosis. The severity of endometriosis is not related to the amount of discomfort or the number of symptoms experienced. Some women have moderate endometriosis with severe symptoms, and others have severe endometriosis with no symptoms.

Don’t take the symptoms of endometriosis lightly. Image courtesy: Shutterstock
Endometriosis’ impact on fertility

Endometriosis can affect fertility, because of the inflammation and irritation it causes. The fimbria, which picks up the egg and carries it into the fallopian tube, becomes inflamed, causing swelling and scarring, and the egg does not reach its intended destination. When sperm and eggs are exposed to the inhospitable atmosphere caused by endometriosis, the inflammation destroys them. Endometriosis causes adhesions, and the pelvic organs get fused to each other, resulting in reduced function in more advanced cases. Endometriosis can also cause the fallopian tubes to become blocked. Your doctor will only make the diagnosis with laparoscopy, until the endometriosis has developed an endometrioma, a cyst on the ovary that can be seen with a sonogram. A scope is inserted through the umbilicus and into the abdomen during this minor outpatient procedure. During the laparoscopy, the doctor will use cauterization, laser, or scissors to remove any endometriosis.

Endometriosis and pregnancy

Pregnancy, fortunately, helps to alleviate endometriosis. Since the hormones released cause the majority of endometriosis to resolve, our team tries to assist women in becoming pregnant before conducting laparoscopy. A laparoscopy is needed when endometriosis is so extreme that pregnancy is impossible. The first few months after surgery are when you have the highest chance of becoming pregnant. Your doctor will take precautions to avoid endometriosis from recurring after pregnancy has occurred, and the majority of the endometriosis has resolved. 

Breastfeeding, like birth control pills, delays the progression of endometriosis. We suggest beginning birth control pills after a patient has finished breastfeeding, and before she wishes to conceive again. This strategy would give you the best chance of getting pregnant, without having to go through another laparoscopy or some other infertility care.

Endometriosis can lead to painful sex as well. Image courtesy: Shutterstock
Endometriosis and infertility 

It might be more difficult to become pregnant, if you have endometriosis. Infertility can affect anywhere from 30-50 percent of women with endometriosis. Endometriosis may affect fertility in a variety of ways, including distorted pelvic anatomy, adhesions, scarred fallopian tubes, inflammation of pelvic structures, immune system dysfunction, changes in the hormonal environment of the eggs, disrupted pregnancy implantation, and altered egg content. Your doctor may calculate a ‘score’ based on the number, position, and depth of endometriosis at the time of surgery. This number decides whether your endometriosis is minimal (stage 1), mild (stage 2), moderate (stage 3), or extreme (stage 4). The success of a pregnancy is linked to this scoring system. Women with extreme (stage 4) endometriosis, which results in significant scarring, blocked fallopian tubes, and damaged ovaries, have the most trouble conceiving and also require advanced fertility treatment.

  • 85
About the Author

Dr Pallavi Prasad, Fertility consultant, Nova IVF fertility, Bangalore ...Read More

Next Story