One of the reasons why some women just cannot get pregnant is due to a condition called endometriosis which often leads to fertility problems and even infertility in 30-50% of cases. Many women with this condition suffer from excruciating menstrual pain, but due to the lack of conversation about this topic in society, it is often referred to as the silent disease.
But what even is endometriosis?
Endometriosis is the appearance of endometrial tissue outside of the uterus. It is a relatively common chronic benign disease that, according to gynaecological experts, affects approximately 15% of women of childbearing age.
The different degrees of endometrioses are commonly referred to as minimal, mild, moderate or severe. In Assisted Reproduction they are known as stages I, II, III and IV.
While in stage I, superficial adhesions are found in the ovaries, in stage IV, these adhesions are deep and the endometriomas occupy an extensive part of the ovaries. In many cases, these adhesions are firm and affect more areas besides the reproductive organs.
Women suffering from endometriosis tend to have fertility problems and a hard time conceiving. A cure for this condition has yet to be found but it’s symptoms such as pain, especially during menstruation, can usually be treated with painkillers or even surgery.
Endometriosis – What causes it?
Even though the symptoms are treatable, sometimes to the point of their disappearance, the causes of endometrioses are still unknown and determining its origin is impossible. In many cases, not being able to get to the root of the problem, can lead to recurrent development of adhesions and pain.
But some theories attempting to explain the causes of endometriosis do exist.
One of them is called Retrograde menstruation which usually appears in medical conditions surrounding uterine malformations. This theory suggests that menstrual blood containing endometrial cells flows back through the fallopian tubes and into the ovaries and pelvic cavity, where they manage to implant, causing endometriosis.
Another theory is called Coelomic metaplasia. According to this theory tissue from the peritoneal area transforms into endometrial tissue in places where it does not belong.
Other experts theorise the cause for endometriosis lies in one’s own immune system. According to this theory, small endometrial-like tissue appearing outside of the uterus is being tolerated due to problems in the immune system and thus generating clinical or subclinical endometriosis.
These theories might help the over 170 million women worldwide suffering from this condition to better understand the causes of endometriosis but research in this field needs to continue to advance. In many countries association such as “Endometriosis UK” were founded by affected women with the aim to raise awareness about this condition and sensitise society to the current lack of knowledge about women’s health: If a women’s life is limited because of her menstruation, there is a problem.
It is also important to highlight the psychological impact endometriosis has on women:
- Depression and anxiety
- Excruciating pain
- The lack of research on this condition
- A society, ignorant to the suffering endometriosis brings
- Sometimes even infertility
All of this can greatly affect the quality of life of women suffering from endometriosis which is why it’s so important to raise awareness about this condition.
In what ways does endometriosis affect my ability to become pregnant?
As already mentioned, endometriosis occurs when the tissue that lines the inside of the uterus grows outside of it. Conceiving through “conventional” ways can be complicated if you suffer from this condition as it causes infertility in 30%-50% of cases.
In the world of Reproductive Medicine, endometriosis and infertility often go hand in hand. Endometrial alterations that affect embryo implantation, scarring of the fallopian tubes or ovaries, toxic effects on the sperm and eggs or hormonal imbalances that reduce the quality of ovulation are only some examples of how endometriosis can affect your fertility.
How to diagnose endometriosis
On average, specialists take 8 years to diagnose a woman with endometriosis. It is not a condition that is easy to detect. Therefore, we at IVF-Spain Madrid highly recommend a prior examination of female fertility if you wish to become pregnant.
The final diagnosis is usually made after a vaginal ultrasound. In cases of severe endometriosis, on the other hand, a laparoscopy is performed. A laparoscopy is a minimally invasive procedure that can detect cysts (also called endometriomas or chocolate cysts) or the presence of pelvic adhesions.
A blood test that analyses the levels of the CA-125 protein can also be performed. The CA-125 protein is a tumour marker that may be elevated in cases of certain cancers and other diseases such as endometriosis I and II. But it is not seen as relevant for the diagnosis of endometriosis as the level may be altered by the presence of ovarian cancer, fibroids, or menstruation itself.
How to treat endometriosis if I want to get pregnant?
Symptoms of endometriosis may vary strongly. The most common symptom is pain, usually during a woman’s period but this is not always the case. Other symptoms may include back pain, abdominal pain, or pain when urinating. There are times when the symptoms of endometriosis can be confusing, and some women may not even experience any symptoms (asymptomatic endometriosis).
Professionals initially opt for medical treatments that are less invasive than surgery. Depending on the stage of endometriosis and a patient’s wish to become pregnant, treatment can begin with contraceptives, analgesics, 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.
To improve the likelihood of getting pregnant with endometriosis fertility specialists may recommend laparoscopy before starting treatment.
Endometriosis: Which fertility treatment is the best option?
Which fertility treatment will be the best option for someone suffering from endometriosis depends on the degree of their condition.
For patients with moderate or severe endometriosis In Vitro Fertilisation , either conventional IVF or ICSI, will be the best option. It is also the next best option when Artificial Insemination was not successful.
Surgery as a treatment for endometriosis may damage healthy tissue which can negatively affect a woman’s fertility even further. Therefore, egg donation might be the only choice to achieve pregnancy.
Endométriose et grossesse
After being diagnosed with mild or moderate endometriosis, patients have the choice to freeze their fertile eggs. Vitrifying one’s eggs is a great option for women who want to postpone their motherhood to a later time, even if their endometriosis has progressed and affected their ovarian reserve.
Why it’s important to diagnose endometriosis
It is not unusual for women that visit our fertility clinics because of reasons relating to difficulties becoming pregnant to be diagnosed with endometriosis.
But endometriosis does not make it impossible to become pregnant. Lidia, one of our patients in Alicante, achieved her dream of starting a family thanks to IVF even after her operation for severe endometriosis. This is why we want to highlight, that to be able to give our patients the best and most successful treatment it is very important to know their exact diagnosis.
If you want to start your family and have difficulties becoming pregnant, feel free to contact us and consult your case with our experts in gynaecology and assisted reproduction.