Does endometriosis affect fertility?
By Moona Arabkhazaeli, MD
Minimally Invasive Gynecologic Surgeon
Introduction: Treatment Options
More than 10% of women between the ages of 15 and 44 have endometriosis – so the negative impact of endometriosis on fertility is experienced by many, many women. Of women who have endometriosis, about 30-50% of them suffer from infertility. Conversely, of women who present with infertility, 25-50% of them are estimated to have endometriosis. These statistics are not meant to be discouraging; rather, increasing awareness can lead to more solutions!
How does endometriosis affect fertility?
This remains uncertain, but there are several theories:
- Mild disease is associated with a release of inflammatory markers in the abdomen and pelvis, which may impair the processes needed for conception (development of follicles for ovulation, fertilization and implantation).
- Advanced endometriosis may lead to scar tissue and distorted anatomy. This can disrupt ovulation or the function of the fallopian tubes.
- Advanced endometriosis, particularly endometriomas (endometriotic cysts in the ovaries), can also negatively impact the ovarian follicles leading to reduced ovarian reserve.
How do I know if my infertility is related to endometriosis?
Fertility is complex and often multifactorial, so the first step is to have an open discussion with your women’s health provider. Endometriosis can be suspected based on history or imaging (see previous blog post for information on symptoms and diagnosis), but can only be definitively diagnosed surgically with a laparoscopy. However, a laparoscopy is generally not the first step in an infertility evaluation, as it should not be assumed that endometriosis is the sole cause. Rather, one should undergo a thorough infertility evaluation, which consists of labs and imaging. Then, depending on your results, your history, and your goals, you and your provider may choose to pursue a laparoscopy. Of note, the fertility benefit of surgery for asymptomatic endometriosis has not yet been proven, so generally surgery is only pursued if someone has symptoms of endometriosis.
Are there treatments for endometriosis-related infertility?
Yes! There are several options.
One option is to undergo a surgical resection of endometriosis. In one study of 586 patients, surgical management was associated with an increase in pregnancy rates (302 versus 186 pregnancies per 1000 patients).
Another option is to undergo fertility treatments. The selection of fertility treatment is based on many factors including medical background, age, preference, cost, etc; it is best to talk through the options with your provider. In the context of endometriosis, the two evidence-based treatment options include ovulation induction with IUI (intrauterine insemination) or IVF (in vitro fertilization). Ovulation iոԁսctiοո plus ІUI has been shown to offset some of the barriers to conception endometriosis poses and has increased chance of pregnancy as compared to natural conception. In comparison, IVF may maximize chance of a pregnancy however it does have higher cost and a more invasive technique compared with ovulation induction with ІUІ. Those who may benefit from IVF include people with no success after 3-5 cycles of ovulation induction with IUI, people with advanced endometriosis, or other infertility factors (eg abnormal semen analysis, or low ovarian reserve).
Endometriosis and infertility are both challenging and emotionally-charged topics, but there are solutions! The above information is meant to spread awareness, and hopefully arm you with a background to have an informed and productive discussion with your provider!
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About the Author
Moona Arabkhazaeli, MD
Minimally Invasive Gynecologic Surgeon
Dr. Moona Arabkhazaeli brings specialized expertise in Minimally Invasive Gynecology Surgery to her role at Minnesota Women's Care. Her dedicated focus lies in areas such as abnormal uterine bleeding, endometriosis, pelvic pain, and fibroids. Dr. Arabkhazaeli's expertise extends to minimally invasive surgical techniques, which optimize patient outcomes by reducing complications and expediting recovery. With a patient-centered approach, she emphasizes compassionate and personalized care, aiming to empower women in their healthcare journey. Dr. Arabkhazaeli's dedication to innovation and her proficiency in minimally invasive techniques underscore her commitment to delivering optimal outcomes for her patients.
If you or someone you know is experiencing the symptoms of uterine fibroids, visit mnwcare.com or call 651-600-3035.