Can endometriosis negatively affect conception?

The disease endometriosis, which is often associated with infertility, is unfortunately often not taken seriously. Yet endometriosis is widespread and approximately every 10th woman is affected. It is a disease of the endometrium, the leading symptom of which is often associated with severe pain during menstruation. Women who experience their periods as very painful are often treated as if they’re just hysterical or exaggerating the severity of their symptoms. They are often thought to have a tendency to be dramatic. However, the pain caused by endometriosis is very real and should not be underestimated. The main symptoms are severe menstrual pain, pain during sex, pain during ovulation, pain during bowel movements, while peeing, pain in the lower back and thighs, nausea and lethargy, as well as reduced fertility, which of course can become a huge problem if you want to start trying for a baby.

Endometriosis is not necessarily the cause of infertility, but there is a link to fertility problems, even if the cause is not fully understood yet due to a lack of research in that area. Even with a severe case of endometriosis, it is still possible to fall pregnant naturally. It is estimated that 60-70% of affected women can naturally fall pregnant despite suffering from endometriosis. In some cases, it may be that the disease affects the reproductive organs. Some women with endometriosis who have fertility problems fall pregnant after medical intervention, either through surgical removal of the endometriosis lesions or through assisted reproductive technologies like IVF.

Clinical decisions are difficult in the treatment of endometriosis-related infertility because few controlled studies have been conducted to evaluate and compare the effectiveness of different treatment modalities. Treatment approaches are usually divided into methods designed to mitigate the disease or simply to relieve symptoms, such as medical therapy with hormonal contraceptives. Affected women should definitely be informed about the risks of reduced ovarian function after endometriosis surgery and/or loss of the ovary. The decision should be reconsidered especially if a woman has already undergone ovarian surgery.

Effective, evidence-based treatment options for endometriosis-related infertility include conservative surgical therapy and assisted reproductive technology. Unfortunately, for patients with endometriosis who wish to maintain or improve their fertility, drug therapy may provide only limited benefits. Although theoretically beneficial, there is no evidence that combining medical and surgical treatment can significantly improve fertility, and it may unnecessarily delay further fertility therapy. The two treatment options of choice, in this case, are surgery or IVF.

IVF treatment is particularly useful when:

• the fallopian tube function is impaired
• infertility is caused by problems on the male part
• other treatments have failed

When it comes to endometriosis and natural conception, the real chances depend firstly, on how severe the endometriosis is and secondly, on factors that are not directly related to the disease. This means, as for any woman who wants to get pregnant, that it is easier under the age of 35. Why is this the case? Well, fertility decreases naturally with age. That doesn’t mean that you can’t fall pregnant after the age of 35 but it means that it might take longer to successfully conceive. Also, your partner might have problems with his sperm. Therefore, both of you should definitely make sure to maintain a healthy and fertility-conscious lifestyle.

A surgical procedure, a so-called laparoscopy, removes lesions and/or endometrial tissue that prevent an egg from traveling through the fallopian tubes. This procedure can also be used for diagnostic purposes. It is considered a fairly uncomplicated, ambulatory procedure. However, if the endometriosis is more severe and, for example, there are endometriotic cysts, that have formed on the ovaries, or blocked fallopian tubes due to the growth of the tissue that normally lines the uterus, it may be decided that these should best be surgically removed. This is done in the hope that ovulation can return to normal, increasing the chances of conception.

If you suffer from endometriosis and are trying for a baby, it is advisable to seek professional help after only six months of unsuccessfull conception, as opposed to one year, which is usually recommended. If you are over 35 it is advisable to look for professional help even earlier. But what are the real chances of getting pregnant with endometriosis?

Well, here’s what the data shows:

If 100 women with minimal to mild endometriosis start trying to get pregnant, 75 of them will get pregnant after one year.

If 100 women with moderate-severe endometriosis start trying to get pregnant, 50 of them will get pregnant after one year.

If 100 women with severe endometriosis start trying to get pregnant, 25 of them will be pregnant at the end of one year.

For comparison, if 100 healthy women without endometriosis start trying to get pregnant, according to statistics, 84 of them will be pregnant at the end of one year.

Sources:

https://www.endometriosis-uk.org/endometriosis-fertility-and-pregnancy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941592/