Understanding Endometriosis: causes, symptoms, diagnosis, and FERTILITY OPTIONS

Endometriosis is a chronic medical condition that affects millions of women worldwide, impacting their reproductive health and overall well-being.According to the World Health Organization (WHO), endometriosis affects an estimated 176 million women worldwide.

In the United States, it is reported that one in ten women of reproductive age has endometriosis.Endometriosis is most commonly diagnosed between the ages of 25 and 40.

In this article, we will delve into what endometriosis is, its potential causes, the symptoms it manifests, how it is diagnosed, and particularly focus on its connection with infertility, exploring solutions such as IVF treatment.

What is Endometriosis?

Endometriosis is a medical condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This abnormal growth can occur on various reproductive organs, including the ovaries, fallopian tubes, and the tissues lining the pelvis. The displaced tissue behaves like the normal endometrium, thickening, breaking down, and bleeding during each menstrual cycle.     

Learn more about endometriosis         

Causes of Endometriosis:

The exact cause of endometriosis remains unclear, but several factors may contribute to its development. These include retrograde menstruation (backward flow of menstrual blood), immune system dysfunction, hormonal imbalances, genetic predisposition, and surgical scars that may promote the implantation of endometrial cells outside the uterus.

Symptoms of Endometriosis:

Endometriosis presents with a range of symptoms, and their severity can vary from person to person. Common signs include pelvic pain during periods or before periods, pain during intercourse, trouble getting pregnant,  and infertility. Other symptoms may include heavy menstrual bleeding, fatigue, and digestive issues. It is crucial for individuals to seek medical attention if they experience any of these symptoms.

How is Endometriosis Diagnosed?

Diagnosing endometriosis can be challenging, as its symptoms often overlap with other conditions. A healthcare professional may perform a pelvic exam, imaging tests, or laparoscopy—a surgical procedure allowing direct visualization of the pelvic organs. Early diagnosis is essential for effective management and to prevent complications.

How endometriosis affects fertility and pregnancy?

According to the American College of Obstetricians and Gynecologists (ACOG), nearly 4 in 10 people with infertility also have endometriosis. Infertility is when someone cannot get pregnant after 1 or more years of trying to conceive, or around 6 months when age 35 or older.
There are multiple ways that endometriosis can affect fertility and make it harder to get pregnant. Adhesions and scar tissue from endometriosis growth can block the fallopian tubes and make it difficult for the egg and sperm to meet.
Endometriomas, a type of ovarian cyst, can grow in the ovaries and damage the ovarian reserve. This can negatively affect the quality of the eggs.

Additionally, endometriosis can cause inflammation, which can hurt fertility. It can also affect the uterine lining and decrease implantation.
Other theories include the following

• Endometriosis growth on the ovaries damages the egg reserve.
• The immune system attacks the embryo.
• The endometrium does not develop properly.

Many people with endometriosis can conceive naturally, and there is no single perfect age for a person with the condition to get pregnant. While a person’s doctor may recommend trying to get pregnant earlier, it is difficult to know a person’s fertility status until they start trying to conceive.

Someone struggling to get pregnant should talk with their doctor about doing an evaluation and possibly discussing treatment options.

Treatments and outcomes vary based on age. Females in their 20s may have a 50% or higher likelihood of pregnancy after one in vitro fertilization (IVF) attempt, while females in their 40s have a 10% chance after one attempt.

What is the best age to get pregnant with endometriosis?

People over 35 may have more difficulty getting pregnant and are more likely to experience miscarriage, stillbirth, and pre-term birth.

Endometriosis is a leading cause of infertility in females. While some people with endometriosis can naturally conceive, approximately 35–50% of females with the condition have infertility.

There are various factors to think of when planning the best time to get pregnant such as peak fertility and lifestyle readiness factors. It is also important to plan for the cost and time involved with infertility treatments.

Learn more about diminishing fertility due to aging
Learn more about getting pregnant when over 40s

How to increase chances of getting pregnant with endometriosis

There are also several therapeutic options, including surgery, medication, and assisted reproductive technology (ART).

Surgery

Surgery aims to remove endometriosis tissue and restore typical anatomy. According to a 2020 critical review and analysisTrusted Source, research has shown that surgery may improve fertility and live birth rates in people with mild to moderate endometriosis.

However, surgery comes with risks including bleeding, infection, and damage to the ovaries and ovarian reserve. This can affect fertility.

A person’s doctor can help them weigh the pros and cons of surgery.

Medication

Some medicines aim to stimulate the ovaries and induce ovulation. A doctor may use these medicines before ART to increase the chance of pregnancy.

Assisted reproductive technology

Examples of ART include intrauterine insemination (IUI) and in vitro fertilization (IVF).

During IUI, sperm is inserted into the uterus. It is sometimes with a medication that stimulates the ovaries. However, IUI may not be effective, especially if endometriosis causes pelvic adhesion or fallopian blockage. 

In IVF, a doctor uses medications to stimulate the ovaries and harvest eggs. They then fertilize eggs with sperm and implant the resulting embryos into a person’s uterus. Some people choose to freeze embryos for later use.

What to know about IVF for endometriosis? 

In vitro fertilization (IVF) has emerged as a viable solution for women with endometriosis seeking to become pregnant. IVF involves the retrieval of eggs from the ovaries, fertilization with sperm in a laboratory setting, and the transfer of the resulting embryos into the uterus. By bypassing the fallopian tubes, IVF can overcome the obstacles presented by endometriosis-related factors and increase the chances of a successful pregnancy. 

Know more about IVF.

Endometriosis is a complex and challenging condition that can significantly impact a woman's reproductive health. Early detection, thorough diagnosis, and exploring fertility solutions like IVF can provide hope and options for those affected by endometriosis. By raising awareness and advancing research, we can improve the understanding of this condition and enhance the quality of life for those navigating the journey with endometriosis.

Consulting with fertility specialists personalizing treatment plans to fit your unique situation. 

Book an appointment with Dr.Deng.