Endometriosis is a common, estrogen-based debilitating gynecological disease. It affects an estimated 10–15% of women during their reproductive years, mostly from the ages of 15 (or as early as a girl’s first period) to 49.
The disease is defined as the presence of endometrium-like tissue that attaches and grows outside your uterus. The endometrium is the lining of your uterus. These pieces of tissue —known as implants—undergo the same cycle as the normal endometrium, but unlike the lining of your uterus, can’t be shed and expelled.
This causes a chronic inflammatory reaction from repeated bleeding, swelling, and scarring. These scars form adhesions. However, sometimes this injured tissue does not just form a scar but comes in contact with another inflamed area nearby in a type of sticky, glue-like manner. For example, they can bind your ovary to the side of your pelvic wall, or they may extend between your bladder and uterus or other areas.
This adhesion formation shouldn’t be confused with adhesions that form from previous surgeries (like a C-section) or those that normally hold organs together.
According to one study, the prevalence of adhesions is 37.6%. The adhesions can vary in appearance from thin, filmy, and transparent to thick, dense, and opaque. In some instances, adhesions have been found to a such extent throughout your pelvis to create what’s been called a “frozen” or “fixed” pelvis. A frozen pelvis occurs when scar tissue binds organs together and seriously impairs their function.
The adhesions cause a number of symptoms:
- chronic pelvic pain before, during, or after your period that has been described as stabbing, sharp, pulling, intense, burning, dull, or heavy
- pain during ovulation
- bowel problems during your period in the form of constipation and/or diarrhea
- pain when urinating
- pain during or after sex
- pain in your lower back
- abdominal bloating
Endometriosis as a role in infertility
According to Endometriosis.org, having endometriosis doesn’t automatically mean you’ll never have children. However, you may have more problems getting pregnant.
If you have endometriosis, you can very well have children without trouble. Some of you may get pregnant, but it could take time. If so, you might need the help of surgery or assisted reproductive technologies (AVT) like in vitro fertilization (IVF)—or sometimes—both.
Could my endometriosis cause my infertility?
One study reported that the prevalence of endometriosis rises to up to 50% in women with infertility, while another study says that the disease occurrence increases dramatically to as high as 30-50% of women having infertility problems.
Endometriosis is associated with an increased risk of having difficulty becoming pregnant. If you’ve already had laparoscopic surgery to diagnose and treat endometriosis, chances are your doctor will have told you that you have a certain stage (not to be confused with stages of cancer) of the disease. According to Boston, Massachusetts-based Brigham and Women’s Hospital, there are four:
- Stage I – Minimal – some isolated areas of disease on the lining of the abdomen and no significant adhesions
- Stage II – Mild – more areas of endometriosis but approximately two inches of the abdomen is involved and there’s no scar tissue
- Stage III – Moderate – a significant amount of endometriosis that may create fluid-filled cysts in the ovaries called endometriomas or “chocolate cysts” due to the brown retained blood. These cysts can run the risk of bursting and spreading the endometriosis to other nearby organs. There may also be scar tissue around the tubes or ovaries along with filmy adhesions.
- Stage IV – Severe – a great deal of areas of endometriosis, possibly large cysts on the ovaries, with possible scar tissue between the uterus and the rectum, and around the ovaries or fallopian tubes. Other areas can also be affected.
Johns Hopkins Medicine explains that the stage of endometriosis is based on the location, amount, depth, and size of the endometrial tissue. This includes:
- the extent of the spread of the tissue
- the involvement of pelvic structures in the disease
- the extent of pelvic adhesions
- blockage of the fallopian tubes
They further explain endometriosis as affecting a woman’s ability to achieve pregnancy through the scar tissue formation that compromises the normal function of the Fallopian tubes. In addition, endometriosis cells could secrete substances that could interfere with the interaction between the egg and sperm. As a result, fertilization doesn’t take place.
They say that women with endometriosis have a high chance of having other hormonal problems that may make transplantation weak and cause early miscarriages. They also reported that women with more advanced endometriosis have poor ovarian function, low egg and embryo quality, and poor implantation of the fertilized egg.
In their research, Drs Matthew Macer and Hugh Taylor found that endometriosis affects early egg formation as well as embryos, the fallopian tubes, and embryo travel to the uterus.
Hugh Taylor, MD is the vice president of the American Society for Reproductive Medicine and chair of obstetrics, gynecology, and reproductive science at the Yale School of Medicine. He reported that if even if you’re diagnosed with Stage I endometriosis, you may be more infertile than someone with Stage IV.
Finally, Brigham and Women’s Hospital also reported that studies showed that endometriosis that is seen at the time of laparoscopy is linked to future fertility.
Ways to overcome infertility due to endometriosis:
According to the Endometriosis Foundation of America, once endometriosis is diagnosed through surgery, doctors say that if a pregnancy doesn’t occur within six months, other fertility treatments involving assisted reproductive technologies (ART) should be discussed. These include:
- IVF – Your eggs are collected and fertilized in a lab, then implanted into your uterus.
- Intrauterine insemination (IUI) – A healthy sperm cell is injected directly into your uterus with proper timing during your menstrual cycle.
- Third-party assisted ART – These techniques are used alone or in combination with other methods. They include egg and sperm donation, or a surrogate (when you’re unable to produce healthy eggs) or gestational carrier (if you’re unable to carry a pregnancy).
Endometriosis is a painful, chronic disease that affects women in their reproductive years and is a common disease in infertile women. It is possible to become pregnant as some women do. However, it can take time.
Ultimately, the best treatment of endometriosis-related infertility is an individual decision you should discuss with your doctor. He or she will discuss options with you to choose the treatments that are best for you. It’s not a battle you should fight alone.