Endometriosis and Infertility: How Are They Related?

One of the most common gynecological disorders worldwide is endometriosis, which can even affect the reproductive function of women.

There is a certain relationship between endometriosis and infertility. However, this doesn’t mean that all women with the disease are “doomed” not to have children. In some cases, appropriate fertility treatment can improve reproductive function. To get there, the doctor will need to assess the extent of the damage.

Endometriosis is a chronic disorder whose main symptom is intense pelvic pain, which is also usually accentuated during menstruation. The pain is a consequence of the growth of endometrial tissue (that is, the tissue that lines the uterus internally) in areas where it shouldn’t grow. This growth is called ectopic endometrial tissue.

The areas most affected by endometriosis are usually the ovaries (and their external surface), the fallopian tubes, and the supporting tissues of the uterus. Less commonly, it can affect the vagina, cervix, vulva, bowel, bladder, or rectum.

According to the MSD Manual, ectopic endometrial tissue not only affects a specific point, but can even cause irritation to the surrounding tissues. It can also cause adhesions to form between structures in the abdomen (which are bands of scar tissue).

As stated in research, the number of women with endometriosis and infertility problems is between 30 and 50%, approximately. On the other hand, it’s interesting to note that 25-50% of the cases of women suffering from infertility have endometriosis.

Causes of infertility

In the portal of the World Health Organization (WHO) it’s stated that the relationship between endometriosis and infertility lies in the effects of the disease itself in the pelvic cavity and the main affected areas already mentioned (ovaries, uterus, and fallopian tubes).

In short, the presence of ectopic endometrial tissue in various parts of the reproductive system (especially the ovaries and uterine tubes) can make it difficult or even prevent the implantation of the embryo.

So, the blockage of the fallopian tubes (and the irritation of the surrounding areas) by ectopic endometrial tissue is what can cause infertility. To help understand this, Dr. Elisa Martín Cano explains the following:

• Under normal conditions, the endometrial tissue lines the uterus (which is a hollow cavity), and month by month it prepares for a possible pregnancy. Therefore, it’s sensitive to hormonal changes.
• If fertilization occurs, the endometrial tissue allows the embryo to implant and prevents it from shedding.
• Ectopic endometrial tissue is also sensitive to hormonal changes, so as menstruation approaches, it can bleed and cause great pain. However, you can also do it during and after it.

The WHO also clarifies that the extent of endometrial lesions doesn’t always correspond to the severity or duration of the symptoms of endometriosis. This means that a woman who has a widespread injury isn’t less likely to become pregnant than a woman who has less widespread injuries.

“The severity of symptoms and the effects of the disorder on fertility and organ function vary greatly from one woman to another” is what the MSD Manual states in this respect.

Treatment

According to the study cited above, endometriosis treatment and assisted reproductive techniques can help a woman to become pregnant. Regarding this, it must always be borne in mind that the success rates are variable.

Treatment options for endometriosis infertility include the following:

• Ovarian stimulation with intrauterine insemination (IUI)
• In vitro fertilization (IVF)
• Laparoscopic surgical removal of endometriosis

Surgical treatment

When a woman who is suffering from endometriosis also suffers from infertility and wants to get pregnant, surgical treatment is usually resorted to. This process attempts to eliminate the greatest amount of ectopic endometrial tissue, but trying not to injure the ovaries so as not to affect reproductive function.

Depending on the stage of endometriosis and its level of involvement, the probability that the woman will get pregnant after surgery increases between 40 and 70%.

Even when surgery succeeds in eliminating all or almost all of the ectopic endometrial tissue, the treatment or medical follow-up doesn’t end there. This is because endometriosis is a chronic and progressive disease. Surgery is a temporary form of treatment.

When all tissue cannot be removed, the patient may be given postoperative treatment with a GnRH (gonadotropin-releasing hormone) agonist.

However, the MSD Manual states that while these types of drugs are useful in controlling the progression of endometriosis, it is unknown whether agonists can improve fertility as such.

• A GnRH agonist helps inhibit the production of hormones responsible for ovulation, the menstrual cycle, and the progression of endometriosis.

In vitro fertilization

Cochrane experts explain that in vitro fertilization is a process in which eggs are taken from a woman’s ovaries, then fertilized with sperm (either from her partner or a donor) to create embryos. Later, these are replaced in the uterus.

Although pharmacological treatment is sometimes prescribed prior to IVF, it doesn’t necessarily have to be done after having received treatment with a GnRH agonist for 6 or more months.

In general, in vitro fertilization is used directly in the following cases:

• When pregnancy doesn’t occur after 6-12 months of surgical treatment of endometriosis
• The fallopian tubes are blocked
• There are other fertility problems

Miscarriage risks

Even when the woman with endometriosis has got pregnant, she must maintain adequate control and treatment, since there are several risks of placenta previa, premature delivery, and spontaneous miscarriage.

Additionally, a women should also try to maintain a healthy lifestyle, in which not only a good diet predominates, but also other good lifestyle habits, including getting enough daily sleep.