If you’ve been diagnosed with endometriosis, or are experiencing symptoms, you may wonder what that means for your fertility. In this article, we’ll break it down for you and share everything you need to know about endometriosis and fertility.
What is Endometriosis?
Endometriosis is when the tissue that is similar to the lining of your uterus grows in other parts of your pelvis or abdominal, such as your ovaries and fallopian tubes. This often causes pain and discomfort, because your body can’t shed this lining when it breaks down each month (like it does during a typical menstrual period). Over time, this leads to inflammation and scarring in the pelvis — which can lead to fertility challenges.
While this condition is painful, it is common and often manageable. In fact, it affects over 500,000 Canadians today. The expert medical team at TRIO has extensive experience treating patients with endometriosis — many of whom have healthy and successful pregnancies.
What are the Symptoms of Endometriosis?
Endometriosis symptoms range and vary from person to person. Some common ones include:
- Pain in the lower abdomen, pelvis, and back that worsens during menstruation
- Pain during or after intercourse
- Pain when going to the bathroom
- Painful, heavy, and/ or irregular periods
- Difficulties trying to conceive
What are the Stages of Endometriosis?
The American Society of Reproductive Medicine has created a system that classifies the severity of endometriosis into stages based on surgical diagnosis. However, the stage of endometriosis does not necessarily reflect the severity of the symptoms you experience.
- Stage 1 (Minimal): A few small areas of endometriosis are seen. No scar tissue is present.
- Stage 2 (Mild): More sites of endometriosis, but less than 2 inches of the abdomen is covered. No scar tissue is present.
- Stage 3 (Moderate): Increased endometriosis with over 2 inches of the abdomen covered. Endometriomas may be present — these are cysts in the ovaries filled with menstrual blood and tissue. Scar tissue may be seen around the fallopian tubes and ovaries.
- Stage 4 (Severe): Large endometriomas in the ovaries and a high degree of scarring in the reproductive tract may be seen.
How is Endometriosis Diagnosed?
Endometriosis is diagnosed by your physician taking a detailed history. However, endometriosis can be difficult to diagnose as the symptoms are like many other gynecological conditions. For a definitive diagnosis, you can undergo a minor surgery called a laparoscopy, and the disease is staged (see above). During this procedure, a general anesthetic is used, and a small incision is made near the navel. The surgeon inserts a thin camera into the pelvis to look for endometrial-like tissue outside of the uterus. Laparoscopy can provide important information about the size and location of the endometriosis.
Does Endometriosis Cause Infertility?
Though some people with endometriosis become pregnant without issues, for many, this condition makes it quite difficult to conceive. Some ways that endometriosis can negatively impact fertility include:
- Endometriomas: Endometriomas are cysts in the ovaries that contain old menstrual blood and endometrial tissue. These cysts are thought to interfere with the balance of progesterone and estrogen in the ovaries, which may inhibit proper egg maturation. Endometriomas can also decrease your ovarian reserve (the number of eggs in the ovaries), which can make it more difficult to become pregnant.
- Inflammation: When endometrial-like tissue becomes trapped in the body, inflammatory cells like macrophages and cytokines are recruited to the area. When this happens in the ovaries, it can reduce egg quality.
- Scarring and Adhesions: Prolonged inflammation can cause scarring to occur in the reproductive tract. Scarring on the ovaries reduces blood flow, lowering the amount of oxygen the eggs receive. This may inhibit egg maturation and reduce egg quality. Scarring along the fallopian tubes causes adhesions to form, which can lead to a blockage, and increases the risk of an ectopic pregnancy.
What are the Treatments for Endometriosis?
While there is no “cure” for endometriosis itself, there are several treatment options that can help alleviate the symptoms, such as:
Pain Management for Endometriosis
Some people manage the discomfort associated with endometriosis by taking painkillers, such as codeine or non-steroidal anti-inflammatory drugs (NSAIDs). Please speak with your physician first so they can guide you on the ideal options for pain relief during preconception.
Hormonal Treatment for Endometriosis
Hormonal treatments like the contraceptive pill or specific injections may help ease the symptoms of endometriosis by stopping the menstrual cycle. However, this is not suitable if you are trying to get pregnant since it prevents ovulation.
Surgery for Endometriosis
During laparoscopy, the surgeon inserts a small camera into the pelvis and a laser, heat, or scissors are used to destroy the diseased tissue. Keep in mind, this is not curative, as endometriosis will regrow after the surgery.
If you are embarking on fertility treatment, your medical team will review your medical history and conduct a series of tests and ultrasounds to create a personalized treatment plan. Your fertility team is here to answer questions you may have and support you at every step.
Fertility Treatment for Endometriosis
The good news is it’s entirely possible to have a healthy pregnancy with endometriosis! In fact, up to 70% of people with mild-to-moderate endometriosis conceive without difficulties. The chances of a successful fertility cycle depend on several factors, such as the severity of your endometriosis, age, hormone profile and other factors. Your TRIO doctor will discuss your treatment options with you to maximize your chances of success.
If you have endometriosis and are struggling to conceive, you’re not alone! There is hope and our team is here to help. Speak to one of our TRIO experts to see how we could help you grow your family.