Endometriosis and Fertility

Having been a fertility consultant for 15 years, I’ve seen and heard first-hand of how endometriosis can affect a patient. And I want you to know this – though it may feel like it, you’re not alone…

1 in 10 women of reproductive age suffer from endometriosis, and it’s also the second most common gynaecological condition in the UK.

Among the most frustrating, worrying and despair-inducing factors of endometriosis, is the fact that getting a diagnosis takes, on average, seven years – years that can be precious in terms of fertility.

The pain can be debilitating, the effect on fertility bewildering. All in all, this condition can have a very real affect on your life. My patients routinely share with me the very serious ways in which it impacts their everyday, as well as their long-term life plans. So today I want to answer the most common questions I’m asked by my patients (as well as addressing the most pressing concerns).

 

First a recap, what is endometriosis?

Endometriosis is where tissue, similar to the lining of the womb, begins to grow in places it shouldn’t – such as on the ovaries and in fallopian tubes.

Endometriosis can affect any woman, of any age, although it’s most common in women in their 30s and 40s.

Although they differ from woman to woman, symptoms of endometriosis can include:

• pain in your lower tummy or back (pelvic pain)
• period pain that stops you doing your normal activities
• pain during or after sex
• pain when peeing or pooing during your period
• feeling sick, constipation, diarrhoea, or blood in your pee during your period
• difficulty getting pregnant
• heavy periods

If you’re suffering from any or all of these symptoms, seeing your GP as soon as possible is imperative, especially where your life is being seriously affected as a result of your symptoms.

 

What causes endometriosis?

Right now, we still don’t know why the growths of this condition occur, although there are two commonly accepted hypothesis:

1. Retrograde menstruation – this is where the blood resulting from a period flows backward into the body, rather than being expelled through the vagina as it should do.

2. Immune system issues – some believe that that those with endometriosis suffer from an immune system that prohibits the body from breaking down endometrial tissue outside of the uterus.

 

Are there treatments for endometriosis?

While endometriosis is certainly a long-term condition, there are treatments out there that can provide promise for reducing your symptoms, including pain-killers; hormone medicines and contraceptives; surgery and operations that could remove parts of the organs affected.

Now for the question you’ve been waiting to ask…

 

Can you conceive if you suffer from endometriosis?

Before I dig into the ways in which endometriosis could be affecting your fertility, I want to be clear: endometriosis DOES NOT mean that there’s little to no chance of conceiving.

In fact, patients with minimal to mild endometriosis enjoy an almost ‘normal’ chance of conception.

While those with moderate to severe endometriosis may have reduced fertility, it’s still not a lost cause. Let’s explore why…

 

The effects of endometriosis on fertility

Work continues to learn more about how, exactly, endometriosis affects fertility. As clinical lead for endometriosis at University Hospitals of Leicester NHS Trust and fertility lead at Leicester Fertility Centre, it forms a daily part of my work. But here’s what we know already…

Conception is where an egg is fertilised by a sperm, which can only happen at the right time during your menstrual cycle. In order for this process to be successful, the sperm must first be of a good enough quality. Then the egg must make the journey through the fallopian tube in order to implant in the uterus. This is a complex process that demands a number of perfect events.

Endometriosis can affect this delicate chain of events in three key ways:

First, endometriosis can lead to cysts that are caused by the build-up of old blood. When these cysts occur in the ovaries, they are capable of destroying the eggs that wait there ready to be released.

Second, there’s the issue of scar tissue, which may diminish the function of the reproductive organs.

Third, endometriosis typically leads to persistent inflammation, which can affect the overall efficiency of the reproductive system.

 

Now for your second most pressing question…

If endometriosis is affecting your fertility, is there a treatment to help?

As an endometriosis sufferer, you may have been advised to begin trying for a family earlier than most. This is indeed an important piece of advice, as the condition can worsen over time.

But beyond this founding piece of advice, you should be aware that there are numerous possible interventions to explore for improving your chances of conception…

• Hormonal treatments as a preventative – Hormonal contraceptive intervention can help to limit or slow the development of lesions. This can both improve your chances of pregnancy once you’re ready for children, as well as minimising the pain experienced as a symptom of endometriosis.
• Minimally invasive surgery – Laparoscopic (keyhole) surgery could go some way to removing lesions, cysts, and scar tissue, all of which can limit the damage to the reproductive organs and allow for pregnancy.
• Egg or embryo freezing – If you’re not yet ready to start a family, but you’re worried about your future fertility, you may want to consider the option of egg freezing, which is particularly effective for those currently in their 20s (as women of this age-range generally have higher fertility).

 

Finally, rest assured that once you do fall pregnant, you needn’t worry about endometriosis affecting the coming nine months in terms of foetus viability (although some women with the condition do report an increase in pain during the first few months).

Women, their partners, families and friends. Endometriosis can be debilitating, confusing, scary, especially when you’re uncertain as to if or how it will affect your fertility.

I’m here to answer your questions and demystify exactly what this condition means for you and your future plans. Get in touch and let’s start that journey today.