WHAT IS ENDOMETRIOSIS AND HOW DOES IT IMPACT FERTILITY?
WHAT IS ENDOMETRIOSIS?
This is a condition where cells from the endometrial lining implant and grow outside of the uterus (including on the ovaries, the pelvic cavity and the fallopian tubes), causing inflammation and scar tissue that can lead to pelvic pain and infertility. Endometriosis is a lifelong condition, but treatment is available.
ARE THERE DIFFERENT STAGES OF ENDOMETRIOSIS?
Yes. There are four stages of endometriosis: from minimal to mild to moderate to severe. Patients with moderate to severe endometriosis have more lesions and scar tissue than women with minimal or mild disease. The higher the stage, the more trouble a woman has getting pregnant. This is because endometriosis creates scars that physically block the sperm from meeting the egg, and also causes inflammation that impairs embryo implantation.
While the stage of endometriosis impacts a woman’s fertility, endometriosis stage does not correlate with pain – a woman with stage IV endometriosis may have minimal pain while a woman with stage I endometriosis may have severe pain.
HOW DO YOU TREAT ENDOMETRIOSIS?
When treating endometriosis, it is important to first identify whether a patient is mainly concerned with addressing her pain versus treating infertility. It is not always possible to simultaneously relieve a patient’s pain and also help her to become pregnant. If a woman is not looking to conceive and just wants to alleviate her pain, over the counter pain killers , as well as hormonal treatments like birth control pills or IUD, can help.
Patients whose main concern is pregnancy will likely require treatment with fertility medications and either artificial insemination or in vitro fertilization (IVF). IVF is the most effective treatment for infertility in patients with endometriosis because it bypasses pelvic scar tissue and enables the sperm and egg to meet in a controlled environment. However, even in IVF, women with endometriosis have slightly lower pregnancy rates than other individuals with infertility.
Once a woman with endometriosis conceives, the pregnancy itself typically reduces her pelvic pain (most likely due to progesterone secreted by the placenta). However, women with endometriosis still have higher rates of miscarriage, ectopic pregnancy, pre-term delivery, placental abnormalities and C-section compared to women without endometriosis.