Endometriosis and Fertility
Endometriosis (commonly known as ‘endo’) is one of the most common gynecological diseases in women of reproductive age. It is an inflammatory condition that affects approximately 10% of women in the general population but up to 50% of women with fertility problems.
Despite being such a common disorder, it can take between 7 and 11 years to get a diagnosis, with many women not being diagnosed until they consult their doctor due to difficulty getting pregnant.
So what exactly is endometriosis, how does it affect your fertility and chances of getting pregnant and what are your options if you want to conceive?
- Endometriosis – what is it?
- What are the symptoms?
- What causes it?
- Getting a diagnosis
- How does endometriosis affect fertility?
- Treatment options for getting pregnant
- How Charting your Fertility can Help
- Endometriosis Video
Endometriosis – what is it?
Endometriosis comes from the word ‘endometrium’, which is the name for the tissue that lines the inside of the uterus or womb. Endometriosis is a condition where this tissue is found growing outside the uterus, on other parts of the body where it shouldn’t be. It typically grows on organs and tissues found inside the pelvic cavity, such as the peritoneum (lining of the pelvis), ovaries, fallopian tubes, bowel and bladder – though it has been found as far away as the lungs and brain!
Just like the endometrium in the uterus, this tissue responds to the reproductive hormones that direct your menstrual cycle.
Each month, reproductive hormones cause the endometrium in the uterus to grow and thicken in preparation for a fertilized egg. If there is no pregnancy, the endometrium breaks down and bleeds and this blood leaves the body as a period.
In women with endometriosis, the endometrial tissue that’s growing outside the uterus also builds up, then breaks down and bleeds. In this case however, the blood has nowhere to go. This can cause inflammation, pain and the formation of adhesions or scar tissue. Ultimately, it can lead to infertility.
Endometriosis can affect any woman or girl of childbearing age, regardless of race or ethnicity. However you are 7 – 10 times more likely to suffer from endometriosis if your mother or sisters have the condition.
Endometriosis – what are the symptoms?
Symptoms of endometriosis vary from woman to woman. However a key feature is pain – mostly in the abdomen, lower back and pelvic areas. The most common symptom of endometriosis is severe pain during menstruation. For many women, this pain can be excruciating and debilitating. Other women experience very little pain however and approximately a third of women with endometriosis don’t have any symptoms at all.
Recent research suggests that those who suffer the most pain are also more likely to have more severe endometriosis and are more likely to struggle with infertility. However this isn’t necessarily the case. The severity of symptoms DO NOT always correlate with the extent of the disease. This means that a woman with extensive endometriosis can experience little or no pain and a woman who experiences severe symptoms can have only mild endometriosis.
Symptoms of endometriosis can include:
- Extremely painful (or disabling) menstrual cramps; the pain may get worse over time
- Pelvic pain at other times of the cycle, not associated with menstruation (this includes lower back pain)
- Pain during ovulation
- Pain during or after sex
- Painful urination or painful bowel movements, especially during your period
- Other bowel problems like bloating, diarrhoea, constipation and painful wind (sometimes diagnosed as Irritable Bowel Syndrome)
- Heavy or long periods
- Premenstrual spotting or bleeding between periods
- Infertility or difficulty getting pregnant
- Chronic fatigue
Endometriosis – what causes it?
[This content is for members only. Please see Step 3 of the Fast Track to Pregnancy Program™ for further information.]
Endometriosis – getting a diagnosis
Unfortunately, getting endometriosis diagnosed can be difficult and it often takes a long time. In fact, on average, it takes around 7 to 8 years to get a firm diagnosis, from the time symptoms are first reported. This is because the symptoms of endometriosis can vary considerably and they often cross over with symptoms of other conditions.
By arming yourself with knowledge however, a delayed diagnosis need not be the case. If you experience some or all of the symptoms above, especially if you’re having difficulty getting pregnant, see your doctor straight away.
This is where your fertility charts can be invaluable (see How Charting your Fertility can Help). By documenting the type, degree and frequency of your pain or other symptoms, your doctor will gain a much better picture of the situation. If your doctor suspects you might have endometriosis, you will normally be referred to a gynecologist (obgyn) for further assessment.
The only way that endometriosis can be definitively diagnosed is through an operation called a laparoscopy (see video below). This would normally be performed in a hospital setting by a specialist gynecologist.
Other testing may be done before this. However if your results from other investigations (such as an internal exam or an ultrasound scan) are normal, this does NOT mean that you don’t have endometriosis.
Once diagnosed, endometriosis is normally classed as minimal, mild, moderate or severe and given a grading of severity from I – IV.
How does endometriosis affect fertility?
Endometriosis is a leading cause of infertility, with an estimated 30 – 50% of women with endometriosis having difficulty getting pregnant. But the good news is, this statistic also means there’s is a very good chance of NOT having fertility problems!!
Even with severe endometriosis, it is still possible to get pregnant naturally. However, the likelihood of experiencing subfertility or infertility does increase as the severity of the endometriosis increases.
By learning the fertility awareness method and charting your fertility you’ll be in a good position to determine whether or not your fertility might be affected (see How Charting your Fertility can Help).
How does endometriosis cause fertility problems?
[This content is for members only. Please see Step 3 of the Fast Track to Pregnancy Program™ for further information.]
Treatment options for getting pregnant
Trying to conceive naturally
In medical terms, trying to get pregnant naturally, without any medical intervention, is known as ‘expectant management’. Many women with endometriosis are able to conceive naturally, particularly if the endometriosis is minimal or mild.
1. Learn fertility awareness. This will help you optimise your chances of natural conception and help you gain insight into whether or not your endometriosis might be affecting your fertility (see How Charting your Fertility can Help).
2. Optimize your diet and lifestyle. This will help create the healthiest possible sperm and eggs (which will increase the chances of successful fertilisation and an ongoing pregnancy). Keep an eye on our blog for more information on this.
If it’s taking a while to conceive, it’s important to remember that there may be other factors involved, in addition to endometriosis. Factors due to the male partner, such as low sperm count, contribute to approximately half of all subfertility/infertility cases, with a combination of factors from both partners often being responsible for fertility problems.
If you’re having trouble getting pregnant, make sure that both you AND your partner are thoroughly checked for any other issues that might be affecting your fertility.
Medication
Hormonal medication (such as the oral contraceptive pill) is often taken to treat the pain caused by endometriosis. This medication does NOT improve fertility however, and pregnancy is usually prevented while these drugs are taken, due to their contraceptive effect.
If you wish to stop your medication in order to conceive, it’s important that you discuss this with your doctor. Stopping medication will usually cause a return of the pain and other symptoms associated with endometriosis. For this reason, many women want to get pregnant as soon as possible after stopping their medication.
Learning fertility awareness and charting your fertility can be a great help in this situation (see How Charting your Fertility can Help).
Surgery
Surgery is usually carried out by laparoscopy (see video below). The purpose of surgery is to restore the normal anatomy of the reproductive organs and remove endometriotic lesions (patches of endometriosis) and endometriomas (chocolate cysts in the ovaries). This also helps to decrease inflammation.
Surgical treatment of minimal to mild endometriosis appears to improve the chances of natural pregnancy by about 40%. It is recommended that couples try and conceive within the first 6 – 12 months after surgery, to optimize their chances.
Again, learning fertility awareness and charting your fertility can be invaluable for this purpose (see How Charting your Fertility can Help).
Assisted Reproduction
A number of different assisted reproduction techniques (ART) can be carried out through specialist fertility clinics. The type and complexity of the technique that is used will depend on a number of factors. These include the severity of your endometriosis and how it appears to be affecting your fertility, your age, how long you’ve been trying to conceive and whether there are any other factors affecting your fertility.
If you have severe endometriosis, your chances of natural conception are significantly reduced (though still possible in some cases). For this reason, it’s worth consulting with a specialist at an appropriate fertility clinic earlier rather than later, to discuss your options.
How Charting your Fertility can Help
If you have endometriosis and you wish to get pregnant, learning fertility awareness and charting your fertility with the Fast Track to Pregnancy Program™ is possibly one of the best steps you can take! Not only will it boost your chances of a quick conception, but you’ll also gain insight into whether or not your endometriosis might be affecting your fertility.
The key benefits of charting your fertility are listed below:
1. Speed up the time it takes to conceive:
Fertility is typically compromised in women who have endometriosis, so it often takes longer to conceive when compared to women who don’t have the condition. The good news is that by using fertility awareness, you can speed up the time it takes to get pregnant.
Timing intercourse correctly each cycle is absolutely vital to maximising your conception chances. The fertile window (days during which intercourse can result in conception) is typically only 2 – 3 days long each cycle so it can be very easy to miss! By learning fertility awareness with the Fast Track to Pregnancy Program™ and charting your fertility, you’ll be able to correctly identify your fertile window each cycle so that you don’t miss an opportunity to conceive.
2. Reduce the need for frequent painful intercourse
Many women with endometriosis experience painful intercourse (dyspareunia), which can cause additional stress and anxiety when it comes to getting pregnant. The good news is that frequent intercourse throughout the menstrual cycle is NOT required to increase your chances of conception.
Having sex just once or twice during your fertile window each cycle is all that’s required to allow conception to occur. (See ‘Speed up the time it takes to conceive’ above).
3. Optimize your chances of natural conception after surgery
Chances of natural conception are significantly increased in the 6 – 12 months following surgery for the treatment of endometriosis, particularly for women with minimal to mild endometriosis. Delaying conception beyond this timeframe may compromise your chances of getting pregnant and women are often advised to start trying soon after surgery.
By learning fertility awareness with the Fast Track to Pregnancy Program™ you’ll be able to optimize your chances of getting pregnant within the 6 – 12 months after surgery.
4. Find out if fertility treatment might be necessary
Many women with endometriosis are fertile and don’t have difficulty getting pregnant (especially those with minimal to mild endometriosis). For others, natural conception is made possible after surgery to treat their endometriosis. Some couples however will need fertility treatment in order to get pregnant.
By charting your fertility and practicing ‘fertility-focused intercourse’ you’ll be able to maximize your chances of conceiving naturally. Natural conception will usually occur within just 6 months (or 6 menstrual cycles) of correctly timed intercourse, though some couples may take up to 1 year of trying.
If you haven’t conceived after 6 cycles of correctly timed intercourse, you may wish to consult your doctor for further investigation (don’t forget to get your partner checked out!) or referral to a fertility specialist to discuss your options for fertility treatment.
5. Monitor and assess your pelvic pain
If you suspect that you have endometriosis or that your endometriosis has returned after having surgery, keeping track of any pelvic pain you experience can be very helpful. Noting the frequency, location, intensity and duration of pain can help you and your doctor assess whether this pain is ‘normal’ or not.
You may also recognize a pattern with your pain, which can help you better prepare for and manage your symptoms. The online charting system that accompanies the Fast Track to Pregnancy Program™ has an area dedicated to the recording of pelvic pain and other symptoms.
For further information on recording and assessing pelvic pain, see Step 3 of the Fast Track to Pregnancy Program™.
Endometriosis Video
Resources
Rogers PA, et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci 2009;16(4):335-46
Sourial S, Tempest N, Hapangama DK. Theories on the Pathogenesis of endometriosis. International Journal of Reproductive Medicine Volume 2014 (2014), Article ID 179515, 9 pages
N. Sinaii, S. D. Cleary, M. L. Ballweg, L. K. Nieman, and P. Stratton, “High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis,” Human Reproduction, vol. 17, no. 10, pp. 2715–2724, 2002.
Cramer DW. Epidemiology of endometriosis. In: Wilson EA, ed. Endometriosis. New York, NY: Alan R. Liss; 1987:5-22.
Simpson JL, Elias S, Malinak LR, Buttram VC Jr. Heritable aspects of endometriosis. I. Genetic studies. Am J Obstet Gynecol. 1980 Jun 1; 137(3):327-31.
Verkauf BS. Incidence, symptoms, and signs of endometriosis in fertile and infertile women. J Fla Med Assoc. 1987 Sep; 74(9):671-5.
Holoch KJ, Lessey BA. Endometriosis and infertility. Clin Obstet Gynecol. 2010 Jun; 53(2):429-38.
Macer ML, Taylor HS. Endometriosis and Infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012 Dec; 39(4): 535–549.
Marcoux S., Maheux R., Berube S (1987). Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. New England Journal of Medicine; 337: 217-22.
Lee et al. Natural conception rate following laparoscopic surgery in infertile women with endometriosis. Clin Exp Reprod Med. 2013 Mar; 40(1): 29–32
Somigliana E, Vercellini P, Daguati R, Giambattista E, Benaglia L, Fedele L. Effect of delaying post-operative conception after conservative surgery for endometriosis. Reprod Biomed Online. 2010;20:410–415.
Gnoth C, Godehardt D, Godehardt E, Frank-Herrmann P, Freundl G. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod 2003 Sep; 18(9): 1959-66
Women with Endometriosis have Higher Rates of Some Diseases. National Institutes of Health News Release.
http://www.endometriosisinstitute.com/endometriosis/treatment-of-infertility
http://emedicine.medscape.com/article/271899-overview – a0156
