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CONDITIONS

Endometriosis and Fertility*

Can You Get Pregnant with Endometriosis?

 

Introduction

Endometriosis is a condition where the cells typical of the lining of the uterus or womb (endometrial-like glands/stroma) are found in other areas of the body, such as the Fallopian tubes or ovary. What happens is that each month these cells build up with blood just like a uterus prepares for menstruation. In this case, there is nowhere for this excess tissue and blood to go, unlike the uterus, leading to inflammation, severe pelvic pain, and/or infertility. It is estimated that endometriosis affects 11% of women between 15 and 44 years of age in the U.S.1

How Endometriosis Affects Fertility

Infertility can affect 30-50% of people with endometriosis.2 Some women with endometriosis do manage to conceive naturally. Endometriosis affects fertility when scar tissue or adhesions block the Fallopian tubes. This makes it difficult for sperm to fertilize the egg. Cytokines are produced as a result of inflammation, and can contribute to infertility through impairment of sperm function, including egg penetration and embryo development. When endometrial tissue attaches to the ovary, it can block an egg from being released. As endometriosis causes pain during sex, this can inhibit sexual intercourse, leading to a lack of conception. Endometriosis does not just affect fertility by physical means but can also have a large emotional impact on the patient.

Causes of Endometriosis

There are several potential causes of endometriosis. It can be genetic, meaning it runs in families. Another cause is a retrograde flow of menstrual blood from the uterus to other areas such as the Fallopian tubes.3 

A faulty immune system can also lead to endometriosis, as it can fail to detect and destroy ectopic endometrial tissue.4 Another cause is surgery such as during a cesarean section where endometrial tissue is accidentally left in another place during the procedure; i.e.near an ovary of Fallopian tube.5

Symptoms of Endometriosis

Endometriosis can present in several ways:

  • The most common symptom is pain. Lower back and pelvic pain, and heavy painful menstrual periods are common.
  • Women also report deep pain during and after sex. Intestinal pain is another symptom and some people experience soreness from urinating during their period or painful bowel movements. 
  • Digestive problems such as bloating, nausea and constipation during menstruation are also symptoms of endometriosis. 
  • Some women experience bleeding or blood spotting between their periods. This can be a symptom of other conditions such as cancer so it is really important to get checked out by a doctor. 

Diagnosing Endometriosis

Many of the symptoms associated with endometriosis are similar to other conditions, and therefore it is important to see a doctor so that the correct diagnosis can be rapidly made. A diagnosis is made using several tests including taking a clinical history and pelvic exam. The definitive test for endometriosis is a laparoscopy, which involves inserting a camera into the pelvis through a small incision near the navel. The surgeon is able to see the organs in the pelvic area, take tissue for sampling, and check for signs of endometriosis. Once a diagnosis of endometriosis has been made, a treatment plan can commence.

Endometriosis is a complex condition and symptoms are varied. It can take a significant amount of time to make a definitive diagnosis.

Treating Endometriosis to Improve Fertility

Endometriosis is a chronic condition, so any treatment is directed at symptom relief and not a cure. Treatments need to be discussed between the patient and clinician to determine which one is optimal. This will depend on age, other medical conditions, and whether you want to improve fertility. People who are near menopause may not need treatment as symptoms may resolve. 

One way of treating endometriosis is with anti-inflammatory drugs to help reduce the pain. 

Hormone treatment is also used in endometriosis. This stops the production of estrogen in the body. Estrogen is responsible for the growth of endometrial tissue, so if this can be reduced, it improves the unpleasant symptoms associated with this condition. 

Some of the hormone treatments used are oral contraceptive pills or intrauterine coils.

Surgery is another option for endometriosis. A laparoscopy can be performed to remove excess endometrial tissue which can improve symptoms and fertility. A hysterectomy is another treatment option for endometriosis but is not an option for those wanting to conceive.

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*NOTICE: The contents of this website are for informational purposes only, and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a potential medical condition.