How Does Endometriosis Impact Your Fertility?

If you’ve been living in the realm of infertility, endometriosis is a term that you have undoubtedly come across. Essentially, it is a medical disorder that occurs within and around a woman’s reproductive system and affects approximately 10 - 15% of the female population (Cohut, 2021) and 30% to 50% of infertile women (ASRM, 2016). Gaining an awareness and understanding of endometriosis is therefore of significance to many women and couples, as this disease can create struggles in their fertility paths, including the course of pregnancy.

In This Article:

1. What Is the Disease Process behind Endometriosis?

2. What Are the Concerns with Diagnosing Endometriosis? 

3. What Tests Are Used to Verify You Have Endometriosis?

4. How Is Endometriosis Classified?

5. How is Endometriosis Treated?

6. What Are the Best Medical Interventions to Optimize Your Fertility?

What Is the Disease Process behind Endometriosis?

Presently, it is not known what causes endometriosis. However, according to John Hopkins University (2022,) there are several risk factors that increase a woman’s chances of developing endometriosis:

• having a first-degree relative (mother, sister, daughter) with the disease

• giving birth for the first time after age 30

• having an abnormal uterus

Wherever this abnormal tissue settles, it behaves like endometrial tissue during your periods by growing, sloughing off, and bleeding. This occurrence results in pain and damage to the tissues and organs involved. The structures in the pelvis, particularly the ovaries and fallopian tubes, are commonly involved, but excess tissue growth can also spread further out to the bladder or intestines and beyond. Consequently, scar tissue and adhesions, along with cysts commonly develop in the affected areas. Blockages may also be present and can decrease your ability to get pregnant by:

• preventing your ovaries from releasing eggs

• blocking the fallopian tubes

  • prevents fertilization

• preventing a fertilized egg from implanting in the uterus

Furthermore, inflammation is another outcome brought on by endometriosis. It creates a negative impact on egg quality and maturation. 

Once a woman with endometriosis successfully conceives, she is unfortunately at higher risk of developing complications during pregnancy, including preeclampsia and placenta previa, which increases the incidence of:

• miscarriages

• prematurely deliveries

• Caesarian births

What Are the Concerns with Diagnosing Endometriosis? 

Recognizing that endometriosis may be an obstacle keeping you from having a baby can sometimes be a long process. This is probably not the news that you want to hear if you are suffering from infertility where endometriosis might be the responsible culprit. As such, being more cognizant about tell-tale signs of endometriosis can be valuable to women who are experiencing fertility issues by helping them alert their medical providers earlier on in their reproductive journey.

Typical symptoms for those suffering from the effects of endometriosis include pain around the ovaries, especially during menstrual periods, vaginal intercourse as well as bowel movements. However, the pain can be felt at other times and may extend out to the lower back and throughout the intestinal tract, if endometrial-like tissue is growing there. As a result, medical practitioners sometimes mistake these symptoms for disorders other than endometriosis. 

Investigation into the root cause of these symptoms may take many years and can be partly due to a woman only realizing she has fertility challenges after having setbacks with conceiving and/or carrying a baby to full-term. Subsequent tests and procedures to confirm an endometriosis diagnosis are only finally performed at a later point in time in the fertility journey. And all too often, a woman may be at a more advanced age before realizing that endometriosis may be an issue contributing to her infertility.

What Tests Are Used to Verify You Have Endometriosis?

After suspecting the presence of endometriosis, your doctor may order a series of procedures and tests. Usually, a pelvic exam and ultrasound are done early on when painful symptoms begin. However, these procedures are more effective at detecting the presence of just cysts, which may confound an endometriosis diagnosis.  

The gold standard used to make a clear diagnosis for endometriosis is a laparoscopy. This surgical procedure involves inserting a narrow tube through a small incision made in the abdominal wall. The tube, also known as a laparoscope, contains a light of high-intensity along with a camera which captures detailed images of the organs in the abdominal cavity and can reveal any signs of endometrial tissue. It also allows your doctor to biopsy tissue samples to establish the tissue type.

How Is Endometriosis Classified? 

Endometriosis can strike women to different degrees. Based on a points system devised by the American Society of Reproductive Medicine (ASRM), looking at how far and deep the disease has spread as well as the bodily structures affected, the following staging classification has been described by Liao (2020):

• Stage 1 or minimal: There a few small implants or small wounds or lesions. They may be found on your organs or the tissue lining your pelvis or abdomen. There’s little to no scar tissue.

• Stage 2 or mild: There are more implants than in stage 1. They’re also deeper in the tissue, and there may be some scar tissue.

• Stage 3 or moderate: There are many deep implants. You may also have small cysts on one or both ovaries, and thick bands of scar tissue called adhesions.

• Stage 4 or severe: This is the most widespread. You have many deep implants and thick adhesions. There are also large cysts on one or both ovaries.

Of note, though, is the fact that scaring and formation of cysts associated with endometriosis will not necessarily spread as time progresses. So, even if a diagnosis is made later on in your fertility journey, it does not always mean that the disease will progress to an advanced stage.

Other important considerations are that conception can be particularly difficult with more advanced stages (3 and 4). Recent studies have also indicated that miscarriages occur at a higher incidence in women with endometriosis, and more so for those with milder cases of endometriosis. At the present time, more research is needed to support these findings and provide a better understanding of the mechanisms behind how endometriosis negatively affects pregnancies.

How is Endometriosis Treated?

The treatment of endometriosis begins with management of painful symptoms with medications.

To help decrease the overgrowth of endometrial tissue, hormonal therapy, including birth control pills, can be administered. However, this treatment is a double-edged sword as it also suppresses the growth of the endometrial lining in the uterus, which usually thickens in preparation for an embryo to implant once conception has taken place. Moreover, therapeutic hormones inhibit estrogen production in the ovaries and ultimately prevent ovulation. 

In more severe cases of endometriosis, surgical removal, often performed during laparoscopic examination, may be advisable. Keep in mind that surgical intervention may cause further scarring, depending on where the tissue is removed.

What Are the Best Medical Interventions to Optimize Your Fertility?

When you are attempting to get pregnant, you might be wondering how to mitigate the undesirable effects associated with established therapies to diminish endometriosis. The best plan of action for you should be developed in collaboration with your doctor and/or fertility specialist, based on the location and extent of your endometriosis, along with the type of symptoms you are experiencing.

Because endometriosis appears to adversely impact the processes involved in conception, implantation, and pregnancy, proceeding with fertility treatments may help to increase your chances of achieving a pregnancy and carrying a baby to full term.

• For Stage 1 and 2 cases:

  • the established strategy of sequentially utilizing clomiphene citrate followed by IUI’s and IVF is attempted to achieve pregnancy

  • IVF may be attempted immediately or sooner if the patient is over the age of 35

• For stage 3 and 4 cases, IVF is recommended if:

  • no pregnancies occur 6 months after surgery

  • blockages and/or scarring are present in the fallopian tubes

In some instances, if ovarian surgery has been recommended to remove endometrial lesions, your fertility doctor may even recommend freezing your eggs beforehand in case your ovaries are damaged during the course of surgery.

With an awareness of the signs and symptoms of endometriosis, advocating for examination of affected areas to provide clear images can help identify the existence of endometriosis more quickly and accurately and at an earlier stage your fertility journey. Again, in determining the best way to incorporate the more invasive treatments involving hormone therapy and surgery, along with upcoming new drug treatments such as nanotechnology (Hottman, 2022), a discussion with your medical team on when to proceed with each form of treatment by weighing their benefits and drawbacks is a vital step towards increasing your chances of having a baby.

Eighteen plus years ago, I struggled with an unexplained diagnosis and then found out I had a chromosomal condition. After 3 cycles of IVF at two different clinics and almost 5 years of fertility treatments, my hard-fought battle with infertility was won when my only son and child was born.

Today, as my IVF miracle enters adulthood and embarks on his own life journey that may also hold fertility challenges ahead, I find myself coming full circle, returning to the world of IVF and reproductive health through my involvement with IVF Warrior. By merging my professional skills as a technical and content writer with my biochemistry and healthcare background, I hope to help others in the midst of their fertility journey make more sense of the oftentimes bewildering medical terminology and concepts surrounding fertility.

~Erika

Medical Disclaimer:

The information provided in this blog is intended for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or qualified medical professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

References:

1. Cohutt, M. (2021, March 30). Endometriosis experiences: The long, painful road to diagnosis. MedicalNewsToday. https://www.medicalnewstoday.com/articles/endometriosis-experiences-the-long-painful-road-to-diagnosis

2. Healthline. (2021, April 5). Getting Pregnant With Endometriosis: Is It Possible? https://www.healthline.com/health/pregnancy/getting-pregnant-with-endometriosis#outlook

3. Healthline. (2022, April 28). How Does Endometriosis Cause Infertility? Everything You Need to Know. https://www.healthline.com/health/endometriosis/how-endometriosis-causes-infertility#takeaway

4. Hottman, S. (2022, May 9). Nanoparticle technology could be new, non-invasive treatment for endometriosis. OHSU. https://news.ohsu.edu/2022/05/09/nanoparticle-technology-could-be-new-non-invasive-treatment-for-endometriosis#:~:text=Nanotechnology%20could%20help%20treat%20endometriosis,and%20Oregon%20State%20University%20found.

5. John Hopkins University. (2022). Endometriosis. https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis

6. Liao, S. (2020, October 24). Endometriosis types and stages. Web MD. https://www.webmd.com/women/endometriosis/endometriosis-types-stages#:~:text=Endometriosis%20doesn't%20always%20go,may%20get%20worse%20or%20better.

7. Mayo Clinic. (2018, July 24). Endometriosis. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656

8. Pregnancy Birth & Baby. (2022, May). How endometriosis affects pregnancy. https://www.pregnancybirthbaby.org.au/how-endometriosis-affects-pregnancy#:~:text=Some%20studies%20say%20that%20endometriosis,will%20have%20a%20normal%20pregnancy.

9. ASRM. (2016). Endometriosis: Does It Cause Infertility?

https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/endometriosis-does-it-cause-infertility/#:~:text=Endometriosis%20can%20influence%20fertility%20in,pregnancy%2C%20and%20altered%20egg%20quality.