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Patient Fact sheet
Endometriosis : Does it cause infertility
What is endometriosis?
When the tissue that normally lines the inside of the uterus (endometrium) is found outside the uterus, it is termed “endometriosis.” Endometriosis may grow on the outside of your uterus, ovaries, and tubes and even on your bladder or intestines. This tissue can irritate structures that it touches, causing pain and adhesions (scar tissue) on these organs.
How can I tell if I have endometriosis?
Many women with endometriosis have pelvic or abdominal pain, particularly with their menstrual bleeding or with sex. Some women have no symptoms. Endometriosis can make it difficult to become pregnant. In fact, 30% to 50% of infertile women have endometriosis. Sometimes, endometriosis can grow inside your ovary and form a cyst (endometrioma). This usually can be seen on ultrasound, unlike other endometriotic tissue. The only way to tell for certain if you have endometriosis is through a surgical procedure called laparoscopy.
Does endometriosis cause infertility?
If you have endometriosis, it may be more difficult for you to become pregnant. Up to 30% to 50% of women with endometriosis may experience infertility. Endometriosis can influence fertility in several ways: distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality. At the time of surgery, your doctor may evaluate the amount, location, and depth of endometriosis and give you a “score.” This score determines whether your endometriosis is considered minimal (Stage 1), mild (Stage 2), moderate (Stage 3), or severe (Stage 4). This scoring system correlates with pregnancy success.
Women with severe (Stage 4) endometriosis, which causes considerable scarring, blocked fallopian tubes, and damaged ovaries, experience the most difficulty becoming pregnant and often require advanced fertility treatment.
How is endometriosis treated?
Medical treatment: Endometriosis needs the female hormone estrogen to develop and grow. Birth control pills and other drugs that lower or block estrogen can be effective in improving pain symptoms. For patients who wish to become pregnant, medical therapy may be considered prior to attempts at conception, but this treatment usually does not improve pregnancy rates.
Will I be able to get pregnant after the surgery?
Surgical treatment: This scoring system correlates with pregnancy success. With more minimal endometriosis, removing or destroying endometriosis can increase your chances of becoming pregnant naturally. If you do not get pregnant within a reasonable time frame after the surgery, it probably won’t help to have surgery again unless there is a new problem. With more advanced endometriosis (Stages 3 or 4), surgery can help restore your normal pelvic anatomy to allow the ovaries and fallopian tubes to work better. Surgery to remove large endometriomas may also improve fertility rates. There is a limit as to how much surgery can improve pregnancy rates. Treatment should be individualized and should consider all available methods to help you become pregnant.
The combination of surgical and medical therapy may be beneficial in patients attempting to conceive through in vitro fertilization (IVF). Overall, treatment is highly individualized for each patient.
The American Society for Reproductive Medicine grants permission to Delhi Gynaecologist Forum to photocopy this fact sheet and distributes to patients.