ENDOMETRIOSIS: Effects on Fertility

Endometriosis is a very common problem among women presenting in fertility clinics.

Is it ignored or its symptoms of cyclical and severe abdominal pain are not treated in timely fashion?
Does delay in treatment affects outcome?
What is the best treatment for it?

This blog would guide about endometriosis, its effects on fertility, various available treatment options and answers to some common queries.

What is Endometriosis?
Endometriosis is a condition in which cells lining the uterus are present outside the uterus. These cells respond to cyclical hormones; as a result during each menstrual cycle they bleed, causing  inflammation and scarring.

What are the sites of Endometriosis?
It has been seen at various places outside uterus like tubes, ovaries, urinary bladder, abdominal walls, intestines, appendix, lungs, and brain.

What are different stages of Endometriosis?
Its staging is done according to size and depth of involved area and extent of scaring.

• Stage 1- Minimal Disease: There are no adhesions or scars; only few endometriotic spots seen in abdomen.
• Stage 2 – Mild Disease: There are no adhesions or scars; less than 2 inches of abdominal area involved.
• Stage 3 – Moderate Disease: There are deep pockets of endometriotic tissue/ fluid in ovaries (Chocolate Cysts) with extensive scarring around tubes
• Stage 4 – Severe Disease: There is scaring and adhesions around ovaries, tubes and gut making a frozen pelvis.

How it affects fertility?
Endometriosis significantly lowers chances of conception, as it affects uterus, ovaries, and tubes. Nearly 30 to 50 percent of women with endometriosis present with difficulty in conceiving.

What is hormonal imbalance in Endometriosis?
There is (LH) luteinizing hormone abnormalities like premature or multiple surges during one cycle causing ovulatory dysfunction, impaired follicle formation and chances of unruptured follicle syndrome.

What is effect of Endometriosis on ovary?
Endometriosis cause Chocolate Cysts formation during periods which may gradually increase in size, damaging normal ovarian tissue, affecting number and quality of eggs. Impaired release of eggs from ovaries and altered hormonal environment also reduce chances of conception.

How are tubes affected by Endometriosis?
There is formation of adhesions which impair tubal function of egg pickup from ovaries and its  transport in tubes. Sometimes scaring around tubes cause complete tubal blockage.

Could Endometriosis directly damage sperms or eggs?
It is possible as it causes generalized inflammation and altered immunity in body, high levels of  inflammatory cells and their chemicals could directly damage or destroy eggs and sperms.

How is uterus affected by Endometriosis?
The lining of uterus becomes hostile due to altered immunity which cause implantation failure.

What are the main objectives of Endometriosis treatment?
The principal aim of treatment is to relieve symptoms, resolution of preexisting endometriosis, prevention of recurrence and all this is increase pregnancy rate of fertility treatments.

How important is time factor in treating Endometriosis?
Endometriotic tissues grow with estrogen hormones, therefore with each menstrual cycle it  increases in size and depth worsening problems of inflammation, scaring and adhesion formation.

How is Endometriosis treated medically?
There are medicines that lower or block estrogen and help in relieving symptoms of pain but will not improve fertility. These medicines are oral contraceptive pills, progesterone pills and some injections.

How important is laparoscopy for Endometriosis?
Laparoscopy is helpful in diagnosing, staging and surgically treating Endometriosis.

What are fertility treatment options  for endometriosis ?
The selection of fertility treatments depends on stage of endometriosis, age of patient and fertility issues. In fact, treatment is individualized for each patient.

• Stage 1 and 2 are benefited by ovulation induction by medicines (oral tablets and injections)
• Stage 3 and 4 require surgical and medical treatment combined with advanced assisted reproductive  techniques of IVF (In Vitro Fertilization)

What is the role of surgery in treating Endometriosis?
Surgical removal of Endometriotic areas may improve chances of conception in Stage 1 and 2 endometriosis. Whereas it is really helpful for stage 3 and 4, as extensive adhesions or endometriotic cysts are removed. Young patients (less than 35 years) surgical and medical treatment help in conceiving. But women with age more than 35 years, after 6 to 12 months of surgical treatment of endometriosis, assisted reproductive techniques of IVF should be offered.

Remember, Endometriosis is a treatable disease. Timely diagnosis and treatment can improve success rate of fertility treatments.

Dr. Ayesha Azam Khan