What you need to know about endometriosis and fertility

Women's Health
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Endometriosis is a fairly common condition, affecting approximately one in 10 women of reproductive age. Endometriosis occurs when tissue similar to the tissue that lines the uterus grows outside of the uterus.

Sensitive to female hormones like estrogen, this tissue is prone to inflammation and can cause severe pain in and around the pelvic area during and between menstrual cycles. Often, inflammation will also involve the intestines and lead to gastrointestinal issues like bloating and nausea.

Many women fear that endometriosis can affect their fertility, and while up to 20 percent may face issues with conceiving, about 80 percent of women with endometriosis will be able to naturally conceive and have a baby, according to Dr. Jordan Klebanoff, a minimally invasive gynecologic surgeon with Main Line Health.

While there is no cure, endometriosis can be effectively managed with either medication or surgery. The sooner you treat the condition, the better your chances of getting pregnant.

What is endometriosis?

Endometriosis refers to tissue, similar to the tissue that lines the uterine cavity, has grown outside of the uterus, like on the fallopian tubes, ovaries, and even on the intestines and bladder. Because this tissue is similar to what lines the uterus, it is thought to respond in the same way to female hormones and can cause a lot of inflammation and pain.

The most common symptoms include very painful periods, pain during sex, chronic pelvic pain with bowel movements, and pain with urination. Some women with endometriosis experience pain between their menstrual cycles, too.

Pain isn’t the only symptom of endometriosis. Many women with endometriosis experience inflammation around the intestines, which can cause gastrointestinal issues like bloating, nausea, and vomiting. These symptoms can have a severe impact on a person’s quality of life. In rarer cases, there may be no symptoms at all.

According to Klebanoff, it remains unclear exactly what causes endometriosis. There is a hereditary and genetic component and the condition has also been associated with:

  • Low body mass index
  • High socioeconomic status
  • The menstrual cycle starting at an early age
  • Difficulty getting pregnant

Endometriosis and its effects on fertility

Evidence suggests that about 20 to 30 percent of women with endometriosis experience difficulties with fertility. Another way of looking at it is that 70 to 80 percent of women with endometriosis will be able to conceive naturally.

Scientists don’t fully understand the link between endometriosis and its effects on fertility.

Klebanoff says the impact endometriosis can have on fertility likely depends on where the endometriosis is. If the inflammation is occurring inside the pelvis, it can lead to scarring and scar tissue that can damage the fallopian tubes and make it difficult to conceive naturally. Inflammation in the pelvis can also make it harder for an embryo to successfully implant in the uterus.

Klebanoff advises his patients with suspected endometriosis who are trying to become pregnant to try to conceive for three or four months. If they still have trouble conceiving after that, he says it’s time to figure out if endometriosis may be interfering so that they can begin treatment. Ultimately, the further you delay treatment, the harder it becomes to conceive naturally.

Can you get pregnant with endometriosis?

Yes. Many women with endometriosis can have children. And once pregnant, the disease should not negatively impact the pregnancy, says Klebanoff. There does not seem to be an increased risk of bad outcomes, such as pre-term birth or early loss.

“Once a woman has become pregnant, even if she has endometriosis, it should not further negatively affect the pregnancy, specifically,” Klebanoff says.

Endometriosis surgery and treatment

Endometriosis can only be confirmed through a surgical biopsy. “That’s the gold standard for diagnosis,” says Klebanoff.

MRI scans and ultrasounds usually only identify very severe cases of endometriosis. The majority of women with endometriosis can have completely normal imaging study results before undergoing surgery. This doesn’t mean that all women who have suspected endometriosis need to undergo surgery to confirm the diagnosis.

Because there is no cure for endometriosis, the goal of the treatments is to minimize symptoms and improve quality of life.

Non-narcotic pain medications — like acetaminophen and ibuprofen — can help alleviate the pain caused by endometriosis. Endometriosis can be medically managed with hormone suppressors such as birth control to reduce the disease process and inflammation it causes. If symptoms improve, it’s a sign that the condition is being treated.

There are also surgical options that can excise the endometriosis and improve the chances of an embryo implanting in the uterus. Endometriosis surgery to help with getting pregnant is most commonly performed through a procedure called laparoscopy, in which the endometriosis or scar tissue is removed.

Many women who have endometriosis will have no issues getting pregnant. For those who do experience fertility issues, there are various medical and surgical options that can help manage the disease and its symptoms.

For more information or to schedule an appointment with a women's health specialist, please call 1.866.CALL.MLH (225.5654).

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