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How does endometriosis affect fertility?
If you are thinking about starting a family while living with endometriosis, you might be concerned about how it could affect your chances of becoming a parent.
In some cases, endometriosis can lead to fertility issues. However, it is still possible to conceive naturally or with assistance from fertility treatments, such as in vitro fertilisation (IVF) treatment.
What is endometriosis?
Endometriosis is a condition where cells similar to those in the lining of the uterus are found in other parts of the body. It is commonly found in the pelvis and can develop in the ovaries and other pelvic organs, such as the bowel or bladder.
The symptoms of endometriosis can vary in severity from person to person. It can interfere with your daily activities and cause pelvic pain, fatigue, painful urination, heavy bleeding and fertility issues.
Many individuals only realise they have endometriosis when they struggle to conceive. It is often at this point that they seek fertility assistance after facing challenges with natural conception.
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How does endometriosis affect fertility?
Many women with endometriosis are concerned about its potential impact on their fertility. Up to half of women with endometriosis will experience infertility to some degree. However, it is important to know that the condition affects individuals differently.
Individuals with mild to moderate endometriosis may take longer than usual to conceive. For those with severe endometriosis, fertility treatments may be needed to become pregnant. In some cases, endometriosis causes damage to surrounding reproductive organs. It can also scar and block the fallopian tubes.
More severe cases of endometriosis can also cause inflammation which can affect egg reserves, fertilisation, and implantation, often resulting in the need for IVF treatment to assist with conception.
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Fertility tests for endometriosis
There are several ways to assess your fertility if you have been diagnosed with endometriosis or are worried you might have it.
One approach is via a laparoscopy. This is a simple keyhole surgery performed under general anaesthetic. During this procedure, a camera is passed through a small incision in the belly button and into the pelvis. This allows the doctors to examine the pelvic organs. A biopsy can also be taken to confirm the presence of endometriosis.
Additionally, imaging tests such as an ultrasound or MRI can be conducted, to evaluate the pelvis and surrounding organs before surgery. Other important tests may include blood tests, clinical history and urine samples.
What does a fertility assessment look at?
AT TFP Fertility, we will carry out a fertility assessment before you undergo fertility treatment. An anti-Müllerian hormone (AMH) blood test will be conducted to measure ovarian reserve (egg supply) and likely response to IVF treatment. Additionally, you will have an antral follicle count (AFC) scan, a pelvic ultrasound, that counts the number of antral follicles. These are small fluid-filled sacs inside the ovaries that contain eggs. This scan assesses how many eggs can be collected if fertility treatment is required and examines the condition of the patient’s womb to check for any abnormalities.
If you’re trying to conceive with a male partner, it might be worth checking if they have any potential fertility issues. This can be assessed through conducting semen analysis. However, this will be discussed with you in detail during your consultation.
You may not be required to come off of any hormonal treatments, for example, contraceptive methods, you are taking to control your endometriosis symptoms. Advice will be given when you book your assessment with us.
Fertility treatment for endometriosis
There are various fertility treatments available that can help increase the likelihood of starting a family. Removing endometriosis by surgery can enhance fertility treatments in carefully selected cases.
The appropriate treatment will depend on the severity of endometriosis, as well as other factors such as age and how long you have been trying to conceive. However, this will be discussed with you in detail during your consultation. Some of these treatments include:
IVF/IUI treatment – In vitro fertilisation (IVF) and intrauterine insemination (IUI) are commonly used fertility treatments that can help improve the chances of conception. It’s recommended to explore IVF or IUI if you have endometriosis and have been trying for longer than two years. However, you may wish to consider treatment earlier, especially if you’re getting to an age where fertility is a concern.
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Fertility preservation – If you are considering surgery, especially where endometriosis is being removed from the ovaries, preserving your fertility may be a good option. Freezing your eggs before surgery will give you the opportunity to try for a child when you are ready.
Surrogacy – Sometimes in severe endometriosis, a major operation called a hysterectomy is performed. This is where the womb is removed to help with heavy and painful periods. In these rare cases, surrogacy is a method of fertility treatment that can be considered. This is when another person carries and delivers a baby for you. The embryo is created using your egg and your partner’s sperm and then placed inside the surrogate’s womb via an embryo transfer.
It is essential to understand that not everyone with endometriosis needs fertility treatment. So, if you do have any concerns contact your doctor for advice.
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Reviewed by Justin Chu, Medical Director at TFP Oxford Fertility.
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