Fertility Preservation Options for Women with Endometriosis

Beyond causing chronic pain and other symptoms, endometriosis poses significant challenges to fertility, making it difficult for many women to conceive naturally.
This article will delve into the relationship between endometriosis and fertility, outlining the steps women can take to preserve their reproductive health.

What is endometriosis?

Endometriosis is a chronic condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This abnormal growth can occur on the ovaries, fallopian tubes, and other pelvic organs, leading to inflammation, scarring, and the formation of adhesions.
Common symptoms of endometriosis include severe menstrual pain, pelvic pain, and infertility. The exact cause of endometriosis is still unknown, but it is a significant factor in fertility challenges for many women.

Find a fertility specialist for endometriosis here. 

How does endometriosis affect fertility?

Endometriosis can significantly impact a woman’s ability to conceive. The condition may lead to the following fertility challenges:

1) Reduced ovarian reserve

Endometriosis can damage the ovaries and decrease the number of available eggs, known as the ovarian reserve.

2) Tubal blockage

The growth of endometrial tissue around the fallopian tubes can cause blockages, preventing sperm from reaching the egg.

3) Pelvic inflammation

Chronic inflammation can affect the reproductive organs, making the environment less conducive to conception.

4) Egg quality

Endometriosis may also negatively impact egg quality, reducing the chances of successful fertilisation and embryo development.

How do you test for fertility with endometriosis?

1) Fertility tests

For women with endometriosis who are considering pregnancy, a fertility evaluation is an essential first step. This evaluation typically involves a series of tests to assess ovarian reserve, tubal patency, and overall reproductive health. The following tests are commonly performed:

1. Anti-Müllerian Hormone (AMH) Test 

   • Measures the levels of AMH in the blood, which is an indicator of ovarian reserve. Learn more about AMH here.

2. Antral Follicle Count (AFC)

   • An ultrasound is used to count the number of small follicles in the ovaries, providing another measure of ovarian reserve.

3. Hysterosalpingography (HSG)

   • A specialised X-ray to assess whether the fallopian tubes are open or blocked.

4. Pelvic ultrasound

   • This imaging test helps detect the presence of ovarian cysts (endometriomas) and assess the overall condition of the reproductive organs.

2) Endometriosis staging and fertility implications

Endometriosis is classified into four stages (I-IV) based on the severity and location of the endometrial tissue growth:

1. Stage I (Minimal)

   • Small patches of endometrial tissue, with little to no scarring.

1. Stage II (Mild)

   • More widespread lesions, but still with minimal scarring.

2. Stage III (Moderate)

   • The presence of multiple deep implants, along with the formation of small cysts on one or both ovaries and the appearance of adhesions.

3. Stage IV (Severe)

   • Extensive implants, large ovarian cysts (endometriomas), and significant scarring or adhesions that may cause organs to stick together.

The severity of endometriosis, as indicated by its stage, often correlates with the degree of fertility impairment. Book an appointment to enquire about the options available to you.

What are the fertility treatment options for endometriosis?

For women with endometriosis who wish to conceive, several fertility treatment options are available:

1) In vitro fertilisation (IVF)

IVF involves stimulating the ovaries to produce multiple eggs, retrieving these eggs, fertilising them with sperm in a laboratory, and then transferring the resulting embryo(s) into the uterus. IVF is often recommended for women with moderate to severe endometriosis or those who have not had success with other treatments. 

2) Intrauterine insemination (IUI)

IUI involves placing sperm directly into the uterus during ovulation. IUI may be considered for women with mild endometriosis, particularly if their fallopian tubes are clear and ovulation is regular.

3) Laparoscopic surgery and ovarian cystectomy

Surgery may be used to remove or reduce endometrial lesions, cysts, and adhesions, potentially improving fertility. This approach is often considered for women who have not responded to other fertility treatments or have severe endometriosis that is affecting other aspects of their health.

What are the factors influencing fertility treatment decisions?

When considering fertility treatments, several factors need to be taken into account:

• Age

  • Women over 35 may be advised to pursue more aggressive fertility treatments.

• AMH levels

  • AMH testing can provide insight into a woman’s ovarian reserve, helping to guide treatment choices.

• Severity of endometriosis

• Personal and family planning goals 

When to seek medical advice?

It’s important for women with endometriosis who are trying to conceive to consult a fertility specialist, especially if you:

• have been trying to conceive for six months or longer without success.

• experience severe pain during menstruation, ovulation, or intercourse.

• have been diagnosed with moderate to severe endometriosis.

• have a known history of ovarian cysts or previous pelvic surgeries.

Seeking timely medical advice can help in formulating an effective treatment plan that maximises the chances of conception while minimising the impact of endometriosis on overall reproductive health.

Conclusion

Endometriosis can present significant challenges to fertility, but with the right approach and timely intervention, many women with the condition can achieve their dream of starting a family. Book an appointment with our fertility specialists at Thomson Fertility Centre for personalised advice and care tailored to your unique needs and goals. 

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a fertility specialist.