Did you know that endometriosis is one of the reasons why some women cannot get pregnant? In 30-50% of cases, endometriosis can lead to infertility. Despite the excruciating menstrual pain that many women with this condition suffer, it is still not very talked about, which is why it’s often referred to as the silent disease.
Let’s start at the beginning, what even is endometriosis?
Endometriosis is a relatively common chronic benign disease. According to gynaecological experts, it affects approximately 15% of women of childbearing age and is characterised by the appearance of endometrial tissue outside of the uterus.
We can differentiate between the following degrees of endometriosis: minimal, mild, moderate and severe. In Assisted Reproduction they are known as stages I, II, III and IV.
In the first stage, superficial adhesions are found in the ovaries, while in the last stage, these adhesions are deep and the endometriomas occupy a large part of the ovaries. In many cases, these adhesions are firm and extend beyond the reproductive organs.
The main symptom of endometriosis is pain, especially during menstruation. Although a cure has not yet been found, different treatments to reduce the symptoms do exist – from painkillers to surgery. It is also very important to note that women who suffer from endometriosis may have problems conceiving.
What are the causes?
Sadly, the causes of endometriosis are still unknown, but the good news is, that the pain and the symptoms that patients suffering from endometriosis have to endure are treatable. Sometimes it’s even possible to achieve their disappearance. Yet, it is impossible to determine the origin of this condition, which in many cases can lead to new and repeated development of adhesions.
However, there are theories that attempt to explain the causes of endometriosis:
- Retrograde menstruation: Medical conditions surrounding uterine malformations. According to this theory, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the ovaries and pelvic cavity. These endometrial cells then manage to implant in these tissues, causing endometriosis.
- Coelomic metaplasia: This theory suggests that tissue from the peritoneal area transforms into endometrial tissue in places where it does not belong.
- Immune system: According to this theory, due to problems in the immune system small endometrial-like tissue appearing outside of the uterus is being tolerated and thus generating clinical or subclinical endometriosis.
Although these are theories that help the 170 million women worldwide suffering from endometriosis better understand the causes of this condition, research continues to advance. In the UK the association “Endometriosis UK” was founded by women suffering from or affected by endometriosis that try to raise awareness about this condition and sensitise society to the current lack of knowledge about women’s health: menstruation should not limit a woman’s life and if it is the case, there is a problem.
How does endometriosis affect conception?
As we already know, endometriosis occurs when the tissue that lines the inside of the uterus grows outside of it. Endometriosis can cause infertility in 30%-50% of cases, i.e. conceiving through “conventional” ways will be complicated.
In the world of Reproductive Medicine, infertility and endometriosis often go hand in hand since it can affect fertility in various ways: scarring of the fallopian tubes or ovaries, toxic effects on the sperm and eggs, endometrial alterations that affect embryo implantation or hormonal imbalances that reduce the quality of ovulation.
How is endometriosis diagnosed?
It is not easy to detect endometriosis. On average, specialists take 8 years to diagnose a woman with it. Therefore, at IVF-Spain we want to emphasize the importance of prior examination of female fertility if you wish to become a mother.
In general, the final diagnosis is made after a vaginal ultrasound and in cases of severe endometriosis after a laparoscopy, a minimally invasive procedure that can detect cysts (also called endometriomas or chocolate cysts) or the presence of pelvic adhesions.
There is also a blood test that analyses the levels of the CA-125 protein, a tumour marker that can be elevated in cases of certain cancers and other diseases such as endometriosis I and II. Although it is not considered relevant for detecting endometriosis, as the level may be altered by the presence of fibroids, ovarian cancer or menstruation itself.
I want to get pregnant: How can I treat my endometriosis?
Although the most common symptom of endometriosis is menstrual pain, usually during a woman’s period, this is not always the case. The symptoms are sometimes confusing or even absent in cases of asymptomatic women. Other symptoms may include abdominal pain, back pain or pain when urinating.
Professionals initially opt for medical treatments that are less invasive than surgery. Depending on which stage of endometriosis a woman suffers from and her wish to become pregnant, treatment can begin with analgesics, contraceptives and other therapies, both hormonal and non-hormonal. This usually improves the symptoms of many patients and helps to monitor the evolution of the endometriosis and to make decisions after analysing the response to the treatment. Surgery, on the other hand, is aimed at women who do not respond to initial treatment or women with other organs affected by endometriosis such as kidneys or intestine.
The fertility specialist may recommend laparoscopy before starting treatment to improve the likelihood of becoming pregnant with endometriosis.
Finally, we must not forget about the psychological impact of this disease. Depression and anxiety caused by pain, the lack of research on this condition that can sometimes even lead to infertility and society itself, unaware of how much pain these women endure can greatly affect the quality of life of women suffering from endometriosis.
Which reproductive techniques are best for women with endometriosis?
Depending on the degree of the condition, different assisted reproductive may be the solution to achieve pregnancy even with endometriosis.
One of the techniques with the best results for patients with moderate or severe endometriosis is In Vitro Fertilisation, either conventional IVF or ICSI. It is also the appropriate option when Artificial Insemination was not successful.
We want to highlight, that surgery as a treatment for endometriosis may damage healthy tissue during the intervention which can negatively affect a woman’s fertility even further. In these cases, patients might have to resort to egg donation treatment.
Egg vitrification allows women to postpone motherhood to a later time, even if in the meantime her endometriosis has progressed and affected her ovarian reserve. Patients will be able to preserve their fertile eggs after being diagnosed with mild or moderate endometriosis.
The importance of diagnosing endometriosis
It is quite common for women who come to our fertility clinics due to problems related to their difficulty conceiving to be diagnosed with endometriosis.
But it is not impossible to achieve pregnancy with endometriosis. Lidia, one of our patients in Alicante, achieved her dream of starting a family thanks to IVF even after her operation for severe endometriosis. But it is very helpful to know the exact diagnosis of a woman who wants to get pregnant through assisted reproduction to be able to give her the most successful treatment option.
If you want to start your family and don‘t know why you just can’t get pregnant, do not hesitate to contact us and consult your case with our experts in gynaecology and assisted reproduction.