Can Endometriosis Affect My Fertility?
Five Facts to Know About Endometriosis and Fertility
Endometriosis is a common gynaecological condition that affects almost ten percent of women. It can give rise to pelvic pain or dysmenorrhoea and in long term affect quality of life. It is seen more commonly in patient seeking fertility treatments. Due to the common incidence and anxieties around its impact on fertility treatments, such as IVF or ICS, I chose this topic for my today’s blog.
What is endometriosis?
Endometriosis is a gynaecological condition where tissue-like the lining of the womb is found in the pelvis or bowel or other parts of the abdominal cavity and, rarely, in other parts of the body too. The condition is found more commonly in patients attending fertility clinics.
The incidence of endometriosis in patients with infertility is almost 30- 50%. Some patients may experience symptoms such as period cramps, difficulties during sexual activity, constipation or diarrhoea around the menstrual period. Other patients with endemetriosis may be totally symptom-free. So, there is no correlation between the extent of the disease and symptoms.
How can endometriosis be diagnosed?
The diagnosis can be established based on the symptoms and the results of the tests. Women experiencing period cramps, deep dyspareunia or infertility are more likely to have this condition.
The ultrasound scan may show cysts in the ovaries which are also called Endometrioma. But, the gold standard test is a minor keyhole surgical procedure called Laparoscopy. This involves making small cuts of a centimetre or less in the belly button area. Through this tiny cut, a surgical telescope (laparoscope) is introduced into the abdominal cavity (inside the belly).
Your specialist will then undertake a thorough assessment to confirm the diagnosis. Your specialist may also consider treating any mild endometriosis at the same time. Major surgery for clearing endometriosis may have to be arranged separately on a different occasion. This requires careful preparation for the best outcome and patient safety.
How does endometriosis affect fertility?
Women diagnosed with this condition are more likely to experience fertility problems or difficulties in getting pregnant. In the general population, women have a one in five chance of conceiving each month of actively trying to conceive.
This reduces to around one chance in ten to twenty tries if you suffer from mild endometriosis. It can be less than one in five or ten chance for those with moderate to severe endometriosis. So, it is well known that endometriosis may affect your fertility.
Does endometriosis affect IVF success rate?
Women with mild this condition may not experience any lowering of the IVF success rate and usually have good outcomes.
If you have moderate to severe endometriosis, then it is possible that it may affect your chances of successful IVF or ICSI treatment. With moderate to severe endometriosis, especially with large endometriomas, some women may experience improvement in the IVF success rates after surgery.
But, it is important to note that surgery can improve IVF pregnancy rates only to a certain extent. It is important that if you have been diagnosed with moderate to severe endometriosis, your fertility specialist or Gynaecologist individualises the endometriosis management before starting IVF treatment to maximise the IVF success rates.
Do I need to undergo surgery for endometriosis before infertility treatment?
It is not essential for every woman diagnosed with endometriosis to undergo surgery. If you have mild endometriosis, then surgery may improve your chances of getting pregnant naturally for some time. You should discuss this with your gynaecologist or fertility specialist.
If you have moderate to severe endometriosis, then you are more likely to need advanced fertility treatments such as IVF. If you have large endometrioma in the ovaries, then you may be advised surgery before starting IVF treatment.
But, it is important to note that surgery can improve the IVF pregnancy rates only to a limited extent. This has to be balanced against the short and long-term risks of having major surgery.