Endometriosis is the condition in which the lining of the uterus, which normally sheds itself monthly when you have your period, grows in other parts of the body, usually in the pelvic cavity. It most commonly occurs in the ovaries, fallopian tubes and the tissue lining your pelvis. Although this can be a painful condition, the most serious complication associated with endometriosis is impaired fertility. In this article we examine the issues around endometriosis and pregnancy, its causes, symptoms and complications as well as the likelihood of getting pregnant with endometriosis. We also look at the various options for effective treatment of the condition, including surgery for endometriosis and fertility outcomes.
In cases of endometriosis, pregnancy is perfectly possible although the fact is that for about one third to one half of women with the condition fertility is impaired. If you are one of the minority of women who experience the condition, it’s understandable that you (and your partner if you have one) will want to know the facts about endometriosis and not least to understand the possible implications for your fertility and chances of having a baby through natural means or with help from an assisted reproduction specialist clinic.
What are the causes of endometriosis?
The name of the condition is derived from the word endometrium. This is the tissue that lines the inside of the uterus and which is naturally lost each month during menstruation. Endometriosis is caused by the presence of this tissue in sites other than its usual place inside the uterus. This tissue is sensitive to the hormonal changes that occur during menstruation including swelling, but unlike the tissue in its normal site, the material has nowhere to go and thus becomes embedded. Although some patients do not notice any symptoms, this can lead to pain, the most frequent symptom, and the other most common complication, which is infertility.
Pain may only occur during menstruation, but there can also be gastrointestinal and urinary symptoms, especially if the stray implants of endometrial tissue invade other structures such as the intestine, the bladder or the rectum. Infertility related to endometriosis can happen as a result of the changes which occur in the pelvic anatomy of patients during their menstrual cycles. It can cause obstruction of the tubes or the formation of endometrioma ovarian cysts. These are also known as chocolate cysts. Therefore, for patients with endometriosis, pregnancy can be difficult to achieve. However the good news is that once pregnant, the pregnancy itself often brings with it a complete but temporary relief of symptoms.
How the symptoms are identified
When it comes to endometriosis and pregnancy, of course it is important to know and identify the symptoms. The suspected diagnosis can be established by the clinic through ultrasound visualisation of chocolate cysts. However, a precise diagnosis can only be made through direct visualisation of the lesions, which are sometimes very small, and it is only possible to identify these via a laparoscopy. This is also known as keyhole surgery, so called because only a small incision is made in the abdomen, allowing insertion of a laparoscope, a small tube that has a light source and a camera, which relays images of the inside of the abdomen or pelvis to a monitor.
How is endometriosis treated?
As a treatment for endometriosis, this type of keyhole surgery can be used not only to confirm a diagnosis but to alleviate pain by removing adhesions or removing cysts. The purpose of conservative surgery is to remove or destroy the deposits of endometriosis. The surgeon can either cut out the deposits (known as excision) or remove them using heat or laser treatment. This type of surgery can provide relief from symptoms, but it is possible that they can recur over time. Complex surgery can involve other organs such as the bowel or bladder and radical surgery could include removal of the ovaries or uterus. These are very different options and clearly the severity of the problem determines the type of surgery for endometriosis and fertility implications that may come with it.
What is the impact of endometriosis on fertility?
Many women with endometriosis conceive naturally even though the condition is frequently associated with fertility problems. Even with severe endometriosis, natural conception may still be possible. However there is a strong relationship between endometriosis and sterility, as it has been observed that 10% of women suffer from endometriosis but 35% of sterile women have it. An added complication is that some types of hormone treatment recommended to alleviate the symptoms of endometriosis can in themselves have a contraceptive action, meaning that women and their partners have difficult choices to make between having children and accessing this type of treatment.
Therefore if you are planning to start a family and experiencing any difficulties in conceiving, it’s a good idea to contact one of our clinics for advice. Before taking what feels at first like a big step, you may like to have a look at our information on what you can expect from your first IVI consultation. It will help to put your mind at rest and provide reassurance that you are not stepping into the unknown. You may also be interested in taking a look at our video introducing IVI: who we are, what we do, our aims and objectives and the record of success that has made us a worldwide leader in reproductive medicine. IVI’s track record speaks for itself: 9 out of 10 couples that consult IVI due to problems with infertility and put their trust in us reach their goal of becoming parents and more than 160,000 babies have so far been born with the help of IVI.
What treatments can help in getting pregnant with endometriosis?
Your consulting gynaecologist will be responsible for making this assessment, taking into account the size of the deposits and cysts and the ovarian reserve or the response capacity of the affected ovary. Surgery for endometriosis and fertility improvement may result. In Vitro Fertilisation (IVF) is often recommended as the appropriate treatment for sterility associated with endometriosis when other techniques have failed.
Endometriosis and pregnancy – what to expect from IVF
With endometriosis, pregnancy may be more difficult to achieve, as we have seen. However, getting pregnant with endometriosis is possible as we have also seen although often some help is necessary in order to achieve the desired result of starting your own family. For those women with endometriosis, fertility issues are not straightforward and what suits one case may not be ideal in another. It is therefore highly advisable to consult an experienced specialist in the field.
When you seek advice at one of our assisted reproduction clinics, it is possible that IVF, the best known and established treatment for a range of fertility issues, will be recommended. If this is the case in your individual circumstances, there is nothing to fear and everything to gain. Here is a summary of the process, or if you would like to check the facts and details for yourself on our website, you can see them here.
First ovarian stimulation takes place, which causes the ovaries, instead of producing a single ovum as in the normal monthly cycle, to produce more oocytes so that a larger number of embryos can be obtained. This takes place at your home country and could span between 10 and 20 days. Next, when the follicles have reached the right stage, we administer hormone treatment which causes the oocytes to mature in a similar way to how they would in a natural cycle. A semen sample, normally from the male partner, is obtained and fertilization then takes place. This process can be done using the conventional IVF method, which involves placing an oocyte surrounded by spermatozoa in a culture plate, or alternatively by using Intracytoplasmic Sperm Injection (ICSI) which consists of inserting a live spermatozoon into the oocyte by puncturing the latter with the aid of a pipette.
Next the best embryos are selected for transfer and inserted into the mother’s uterus with the help of a specially designed cannula. The procedure is carried out in an operating theatre, although sedation is not necessary since it is a quick and painless procedure. Once the embryo transfer has been made, we vitrify the remaining good quality embryos so that they can be used in a later cycle, thus avoiding the need for any further ovarian stimulation.
If you, or you and your partner would like to find out more about the options for treatment available and exactly what is likely to be involved, why not contact us at IVI and make your first appointment? It’s easy to do, and it could be the first step on your way to finally seeing your dream of having a family come true. You can call us free on 08 000 850 035 if calling from the UK or on +34 960 451 185 if calling from other countries. Alternatively, you can use the contact form on our website and one of our specialist advisers will contact you. We look forward to hearing from you.