Endometriosis, Fertility And Infertility

One of the biggest fears of women who have been diagnosed with endometriosis is that they will not be able to get pregnant. You may have more of a chance then you think, fortunately, especially when you consider artificial reproductive techniques. 

Endometriosis — A Brief Overview

Endometriosis is a female reproductive disease that affects approximately 178 women worldwide. In women with the disease, the tissue that should line only the uterus — and that is usually expelled during a woman's menstrual period — has invaded other organs too. The fallopian tubes, ovaries, bladder and intestines are the most common examples of affected organs.

Endometrial tissues that can't be shed during menstruation, because they are outside of the uterus, obviously lead to problems within the reproductive system. Cysts, adhesions or scars, and invasive nodules are all possible results of endometriosis. One consequence of endometriosis is blocked fallopian tubes; something that can lead to both infertility and ectopic pregnancy.

While some women with endometriosis suffer such symptoms as pelvic pain, painful sexual intercourse, and irregular vaginal bleeding, others do not have any noticeable symptoms. For some, the inability to get pregnant is the very first indication that they may have endometriosis.

Endometriosis Infertility Statistics

The statistics concerning endometriosis and infertility speak for themselves:

• 25 to 50 percent of all infertile women suffer from endometriosis.

• 30 to 50 percent of women with endometriosis are infertile.

• Nine to 50 percent of women who undergo a laparoscopy to evaluate infertility suffer from endometriosis.

• 30 to 80 percent of women who suffer from regular pelvic pain have endometriosis

• Healthy couples have a 15 to 20 percent chance of getting pregnant within a given menstrual cycle, while those couples in which the female partner has endometriosis have a two to 10 percent chance of conceiving during a given month.

These statistics come from scientific studies examining infertility and endometriosis (you can find sources in the link box below, if you're interested in reading more). Despite the fact that these figures suggest a strong link between infertility and endometriosis, the exact mechanism by which the disease leads to infertility is everything but clear.

There are a few theories, as always. Women with endometriosis may have altered hormonal and ovulatory function, resulting in a luteal phase dysfunction. This is when the second part of the menstrual cycle, the luteal phase, is too short to allow a fertilized egg to implant into the lining of the uterus. Then, it is also possible that the endometrium within the uterus reacts abnormally, making it hard for a fertilized egg to implant. It is also feasible that eggs transport differently from the ovaries through the fallopian tubes into the uterus. This is definitely the case in women who have blocked fallopian tubes as the result of endometriosis, but can also happen in women with apparently normally functioning tubes.

Trying To Get Pregnant With Endometriosis

What are your real chances of getting pregnant with endometriosis? As you can see from the wide range in the suggested statistics above, that is not completely clear. We will look at three different paths toward conceiving with endometriosis.

Conceiving naturally is the option every woman with endometriosis hopes will work for her. Laparoscopic excision surgery and IVF are two alternative options that can be very successful.

Conceiving Naturally

Studies suggest that women with endometriosis have a two to 10 percent chance of conceiving during any one cycle. If you have minimal to mild endometriosis (stages I and II), you may have a good chance of getting pregnant naturally.

Randomized clinical trials suggest that hormonal therapy with progestin and gonadotropin-releasing hormone (GnRH) antagonists are not effective in increasing the pregnancy rate. Those women who have stage I or II endometriosis may be able to get pregnant naturally without those treatments, in which case the same advice that also applies to any other woman who is trying to conceive should be followed.

This amounts to a healthy and balanced diet, tracking the menstrual cycle, and monitoring ovulation through methods such as ovulation predictor kits or charting basal body temperature. You will want to keep an eye on the length of your luteal phase — that is the time from ovulation to menstruation. The average luteal phase lasts 14 days, and should be at least seven to 10 days long for a fertilized egg to successfully implant.

Remember that the definition of infertility is the inability to conceive within 12 months of actively trying. Women who have reached that unfortunate milestone will want to start investigating other options with their specialists.

Laparoscopic Excision Surgery

Laparoscopic excision surgery is referred to as the gold standard in endometriosis treatment by the Endometriosis Foundation of America. This surgery is designed to remove all endometrial implants from surrounding organs, including the fallopian tubes, in order to reduce symptoms and restore normal function.

Studies have shown that the chance of achieving pregnancy goes up slightly in women with minimal to mild endometriosis who have had the laparoscopic excision surgery. In those patients who have severe endometriosis, the benefits of the surgery are more obvious. The pregnancy rates within two years of the surgery were as high as 63 percent.

Do note that endometrial implants are very likely to recur over time, along with cysts and adhesions. Further (small) studies have suggested that there is little benefit to a woman's fertility if laparoscopic excision surgery is repeated. This population is more likely to benefit from artificial reproductive techniques, specifically IVF.

IVF And Endometriosis

A recent report on the general IVF success rates in all women shows that the overall birth rate per IVF cycle is 44.6 percent in women under 35, and 14.9 percent in those who are between 41 and 41 years of age. Amazingly, the chance of having a baby as 39.1 percent in all women with endometriosis, across the ages. Keep in mind that the average age at which women are diagnosed with endometriosis is 27, giving them quite enough time to have IVF before they reach age 35.

There are various studies into the success rates of IVF in women who have endometriosis, and it is no surprise that research suggests that the chance of getting pregnant and having a baby goes down as the severity of endometriosis increases. It does, however, seem safe to say that IVF absolutely maximizes the chance that a woman with any stage of endometriosis successfully achieves pregnancy and carries that pregnancy to viability.