Endometriosis does impair a person’s ability to conceive and affects fertility in a negative way. Up to half of the women who have been diagnosed with this pathology, were also unable to get pregnant. The opposite is also true: the frequency of the condition among the women with infertility is 35–50%. But with professional medical treatment, it is still possible to try for a conception successfully.
What is Endometriosis?
The name “endometriosis” comes from the endometrium, an epithelial layer that, with its mucous membrane, lines the inner surface of the uterus. The organism sheds its tissue monthly during the period bleedings, and then it regrows. Endometriosis is a condition when such tissue grows outside the uterus. Up to ten percent of female patients between the ages of 15 and 44 get diagnosed with this condition.
Abnormal tissue is most commonly found around the reproductive system’s organs, such as:
- pelvic cavity inner lining;
- uterus’ outer surface and attached ligaments;
- ovaries;
- space between the uterus and the bladder or rectum.
Also, endometrial tissue can grow in the areas of the rectum, bladder, cervix, intestinal tract, abdomen, vulva, or vagina. It is not expelled during menstruation like healthy uterine endometrium but builds up causing painful inflammation and creating cysts, scarring, and adhesions—sticky formations that are able to bind together the nearest organs.
Causes
The etiology of this pathologic condition is unclear. There are some theories suggesting:
- Retrograde menstruation, which is a phenomenon of menstrual blood getting back into the fallopian tubes and, through there, to the pelvic cavity. The endometrial cells contained in the menstruation discharge adhere to pelvic organs or inner lining and continue to grow.
- Transformation of the peritoneal cells (which create the inner surface of an abdominal cavity) or embryonic cells (cells in the earliest development stage) into endometrial cells under the effect of immune or hormonal factors.
- Transplantation after surgery. Some operations, such as a C-section or hysterectomy, may lead to the attachment of cells to the surgical incision.
- Transportation through the blood vessels or lymphatic fluid.
- Genetics. Studies show that the patient is more likely will be diagnosed with endometriosis, if their closest relatives (mother, sister, etc.) had had it, too.
- Immune system abnormalities.
Additional risks
Some factors can increase the patient’s risk of developing endometriosis:
- Not having childbirth previously.
- Early start of menstruations.
- Unusual cycle—for example, very short (less than 27 days) or with the long and heavy stages of bleeding (more than a week).
- High levels of estrogen in the body.
- Low BMI (body mass index).
- Medical conditions that obstruct the blood flow out of the organism during periods.
Symptoms
The signs that mean you should be alerted about your health and contact your family doctor or an ob-gyn for a consult:
- Dysmenorrhea (very painful sensations during periods). May be accompanied by back and/or lower abdominal pain; it also starts earlier and lasts longer than usual period cramps.
- Pain associated with sexual penetration.
- Painful feelings during urination or bowel movements.
- Heavy menstrual bleeding or long bleeding periods.
- Gastrointestinal disorders, such as diarrhea, constipation, nausea, or bloating that peak during menstruation.
Types
Endometriosis is classified accordingly to an affected area. There are four main types.
Superficial peritoneal
This is the least complicated type of the pathology. In this case, endometrial tissues attach to the peritoneum–the inner abdominal or pelvic lining.
Endometriomas
Endometriomas, also known as “chocolate cysts”, are different in size, fluid-filled formations of dark color mostly found in the ovaries.
Deeply infiltrating
DIE, or deeply infiltrating endometriosis, is the type when abnormal tissue grows outside the pelvic area, reaching the ovaries, bladder, rectum, or intestines. 1% to 5% of patients with DIE develop a so-called “frozen pelvis” when there is so much scar tissue that it connects the organs making them immovable.
Abdominal wall
The most common cause for endometrial cells to attach to the abdominal wall is a surgical incision, such as from a C-section.
Stages
Endometriosis is measured with an American Society of Reproductive Medicine scale that helps medics to assess how much the endometrial tissue has spread, how deep is it, and what parts of the body it has affected. Based on the results of the assessment, there are four stages of the disease:
- First (minimal) is characterized by small formations and damage located in the pelvic or abdominal area, with little to no scar tissue.
- Second (mild) is deeper in the tissues, with more formations and, possibly, the presence of scar tissue.
- Third (moderate) is assigned when there are many deep implants, cysts in the ovaries, and so much scar tissue that it creates adhesions.
- Fourth, or severe, includes large cysts in the ovaries, a large number of deep implants, and thick adhesions.
Diagnostic
Endometriosis and infertility commonly go hand in hand: in fact, the pathology is often found only when the patient is trying for a child without success. An effective way to diagnose the condition is a laparoscopy: a minimal surgical invasive operation that not only allows your doctor to determine if you have endometriosis but also to evaluate the type and stage of the disease.
It is done under general anesthesia, so there is no need to worry, as the patient does not feel anything. During the procedure, the surgeon makes a tiny incision and put in it a laparoscope, an instrument that has a camera and a light. With its help, the doctor can find endometrial tissue implants and identify how much they progress. If the tissue looks suspicious and the doctor suspects that it may be cancerous, a small sample will be taken for the biopsy.
There are also non-invasive diagnostic methods that doctors use before discussing a surgery. For example, an endometrioma can be found through an ultrasound or MRI, and cysts can be felt when the specialist performs a pelvic exam.
Endometriosis and Infertility
Endometriosis causes infertility in several different ways:
- ovarian cysts complicate release of the egg;
- scar tissue prevents the fertilized egg from getting into the uterus;
- tissue damage makes it harder for an egg to implant inside the uterus;
- sperm or eggs get damaged easily with scar tissue.
Endometriosis Fertility Index
Endometriosis and fertility level are evaluated through Endometriosis Fertility Index (EFI): a system of scores that helps doctors to suggest the possibility of conception after laparoscopic surgery. Depending on the results, they decide if additional medical assistance will be required after an operation.
Apart from the condition type and stage, EFI takes into account such factors as maternal age, how long the patient attempted to conceive, and the anamnesis of previous pregnancies.
Fertility Treatment for Endometriosis
According to studies, 30% to 50% of the women diagnosed with endometriosis, cannot conceive. Despite that, it does not exclude the possibility to get pregnant. Modern medicine can help you manage your condition enough without affecting your hormonal balance so you will be able to conceive.
Intrauterine insemination
IUI, or intrauterine insemination, is a procedure that involves the direct insertion of sperm into the uterus. It is quick, simple, and usually not painful, and you can go home right after.
Sometimes, it is recommended to have a course of fertility medication before, to increase the number of eggs and, thus, the possibility of successful fertilization. The sperm used for IUI can be obtained from the person’s partner, a friend, if possible for the legal matters, or a sperm donor.
In vitro fertilization
IVF, which is an abbreviation for in vitro fertilization, is a more complex reproductive technology. Hormonal treatments that cause the ovaries to start producing eggs are the first step in the procedure. The effects of the drugs on your body are observed throughout your cycle. Your physician can track the development of your eggs using blood tests and ultrasounds.
When your follicles are at the appropriate size, it is time to start an egg retrieval procedure. It is carried out under anesthesia and results in the retrieval of your eggs from the ovaries. Then, they are taken to be mixed with sperm and get fertilized in safe and sterile lab conditions. After, they stay in the lab as embryos to grow and mature, under careful monitoring. When ready, embryos are either delivered to the uterus or get saved in the frozen state for future implantation.
The direct transfer to the uterus happens similarly to IUI: with the help of a cervical catheter.
Laparoscopy
Laparoscopy can also be used to treat endometriosis, which often occurs right after the surgical diagnostic. In this case, the second incision is made, for insertion of the tools that the surgeon uses to remove implants and scar tissues. The removal can be performed with three methods:
- Excision, done entirely with surgical tools through mechanical elimination of pathologic tissues.
- Laser ablation, when the tissues are destroyed with intense heat.
- Cauterization, when the same effect is achieved with electricity.
Laparoscopy treatment has a comparatively short recovery time and leaves small scars.
Other treatment methods
Endometriosis can be treated with hormonal therapy aimed to limit estrogen as its the hormone that causes the growth and shedding of endometrial tissues. But these method involves oral contraceptive pills or progestogens that suppress fertility which is why we do not view them in this article.
Summary
Endometriosis is a pathology when uterine lining tissue starts growing outside the uterus, causing pain, scarring, inflammation, and excessive bleeding. It worsens the patient’s quality of life and complicates conception if they are trying for a child. The condition can be diagnosed with an ultrasound, MRI, or dedicated surgery, sometimes with a combination of those. Being diagnosed with endometriosis does not mean that you cannot become a mother: depending on the course of the disease, the doctor can offer you the best and most effective treatment option. If donor sperm is used, it will be delivered to the clinic and thawed before the procedure; if not, the provider will give the sperm obtained via masturbation to be purified and concentrated, on the day of treatment.
FAQ
Can Endometriosis Cause Infertility?
Endometrial tissue growth can significantly complicate the fertilization and implantation of the egg that are required for pregnancy. If the person tries to conceive without success for a long time, they can be diagnosed with infertility, which means that endometriosis can cause infertility or contribute to its development.
How does endometriosis cause infertility?
Abnormal formations outside the uterus lessen the chance of the egg being fertilized with a sperm, then getting inside the uterus and implanting there. As such, pregnancy does not start.
Can you still get pregnant if you have endometriosis?
Yes, surgical treatment and modern assistive fertility technologies allow women diagnosed with endometriosis to conceive a baby.
Is infertility common with endometriosis?
The studies show that 30% to 50% of women with this condition are also infertile.
