The Correlation of Endometriosis with Female Infertility

Woman with abdominal pain

Endometriosis affects about 200 million women worldwide while possibly affecting more than 11% or 6.5 million (1 in 10) American women between ages 15 and 44.

In the U.S., women in their 30s and 40s are most likely to become diagnosed, the decades within women’s health highlighting family planning and childbearing. Recent studies prove endometriosis doubles the risk of infertility. In fact, female infertility is a direct consequence of endometriosis, affecting between 30% to 50% of women diagnosed with the disease, according to the American Society of Reproductive Medicine (ASRM).

Endometriosis, although not life threatening, can imitate several other health issues in those diagnosed, making its diagnosis difficult. It can often take years from the onset of symptoms to confirmation and diagnosis. For some women, endometriosis symptoms go away on their own once they reach menopause.

March is National Endometriosis Awareness Month and your local Capital Women’s Care team would like to empower you with important information about the link endometriosis may have on your reproductive and overall health. We offer you important facts about endometriosis and its symptoms, treatment options that don’t affect subsequent fertility or conception and how you can achieve optimal preconception health by taking charge of endometriosis and its symptoms before trying to conceive.

What Is Endometriosis?

Endometriosis is a common health issue for women, mostly afflicting those in their 30s and 40s. Named for the tissue lining the uterus (the endometrium) endometriosis happens when tissue similar to that within the uterus grows outside and within other areas inside the body.

Endometriosis commonly affects the:

  • ovaries
  • fallopian tubes
  • tissues holding the uterus in place
  • and the uterus’ outer surfaces.

Other sites for endometrial growths may include the vagina, cervix, vulva, bowel, bladder, or rectum. Endometriosis rarely appears within other parts of the body, like the lungs, brain, and skin.

Fortunately, endometriosis growths are not cancerous; however, they can still cause health problems that are serious like bowel obstruction or ectopic pregnancy, both of which require immediate medical treatment.

Endometriosis growths may swell and bleed in the same way the uterine lining does during monthly menstrual cycles. This can cause swelling and pain because tissue continues to grow, rupture and spread.

Expansion of growths cause problems like:

  • blocking fallopian tubes when growths cover or grow into the ovaries, increasing chance of cysts forming from trapped blood.
  • swelling and inflammation
  • formation of scar tissue and adhesions, a type of tissue that can bind organs, which can cause pelvic pain and make it difficult to conceive.
  • and intestinal and bladder problems.

Endometriosis Symptoms

Endometriosis presents several symptoms, which may include:

Pain -- the most common symptom. Women with endometriosis may have many different types of pain, including:

  • very painful menstrual cramps that may worsen over time.
  • chronic lower back and pelvis pain.
  • a “deep” pain within the body during or after sex.
  • intestinal or digestive pain.
  • painful bowel movements or pain during urination during menstrual cycle. In rare instances blood may appear in stool or urine.
  • neuropathy or nerve pain as endometriosis growths spread and affect nerves.

Bleeding or spotting between menstrual periods. This may be caused by something other than endometriosis. Schedule a visit to your doctor if this happens to you regularly.

Infertility. Endometriosis can lead to female fertility issues which cause the inability to conceive.

Stomach and digestive problems. Problems include diarrhea, constipation, irritable bowel syndrome (IBS), bloating, or nausea, particularly during monthly menstrual cycles.

Endometriosis Risk Factors

There is no conclusive evidence regarding the causes of endometriosis. However, experts have found you are more susceptible to endometriosis if you have:

  • Never had children
  • Have menstrual cycles lasting longer than 7 days
  • Experience short menstrual cycles (27 days or less between menstrual cycles)
  • Have a close relative (mother, aunt, sister) diagnosed
  • Have a diagnosed health problem blocking menstrual flow from your body
  • Had previous Cesarean birth or abdominal surgery

Diagnosis of Endometriosis

Your doctor will talk with you concerning your symptoms and recommend one or more of the following to determine if you have endometriosis:

  • Pelvic exam -- During a pelvic exam, your doctor will feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are harder to feel and require imaging tests.
  • Imaging test -- Your doctor may do an ultrasound to check for ovarian cysts. The doctor or technician may insert a wand-shaped scanner into your vagina or move a scanner across your abdomen. Both kinds of ultrasound tests use sound waves to produce pictures of your reproductive organs. Magnetic resonance imaging (MRI) is another common imaging test used to investigate for endometriosis.
  • Medicine -- If your doctor doesn’t find signs of an ovarian cyst during an ultrasound, they may prescribe medicine to lessen your pain. If pain gets better with medicine, it’s highly likely you have endometriosis.
  • Laparoscopy – This is a specific type of surgery used to look inside your pelvic area to see endometriosis tissue. Surgery is the only way to be certain you have endometriosis. Sometimes doctors can diagnose endometriosis by locating and reviewing growths. Additionally, they may need to take a small tissue sample and evaluate it to confirm diagnosis.

Endometriosis Treatments

Unfortunately, there is no cure for endometriosis; however, treatments are available for both the symptoms and problems it causes. Talk to your doctor about your treatment options, which include:

  • Surgery -- Surgery is usually chosen for severe symptoms if you are having fertility issues. After surgery, hormone treatment is often instituted unless you are trying to become pregnant.
  • Pain medicine -- For mild symptoms, your doctor may suggest taking over-the-counter medicines for pain. These include ibuprofen or naproxen.
  • Complementary and alternative medicine (CAM) therapies -- Some women report relief from pain with therapies like acupuncture or chiropractic care, to name a few.

Endometriosis and Female Fertility

Endometriosis causes roughly 40% of female fertility issues. It is considered one of the 3 major causes of female infertility. Causes of female infertility directly relating to endometriosis may be attributed to:

  • Inflammation which may damage sperm or egg or interfere with their movement through the fallopian tubes and uterus.
  • Blocking of the fallopian tubes by adhesions or scar tissue.
  • Developing an ectopic pregnancy. According to an analysis of 15 studies, women with endometriosis are more likely to experience an ectopic pregnancy.

One study found that while 15% to 20% of fertile couples attempting to become pregnant will be successful each month, that number drops to between 2¬% to 10% for couples affected by endometriosis.

Ideally, women wishing to conceive should institute a preconception health plan 3 months minimum before trying to become pregnant.

These treatment options can help manage symptoms and improve chance of achieving pregnancy:

  • Medications to help manage pain symptoms include pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal medications, including birth control pills, doses of progestin and gonadotropin-releasing hormone agonists. Hormonal medications help to slow the growth of the endometrial tissue and may keep new adhesions from forming. Hormonal drugs typically don’t get rid of endometriosis tissue already present and shouldn’t be used by women trying to conceive.
  • Conservative surgery -- is for women who want to get pregnant or experience severe pain. The goal of conservative surgery is to remove or destroy endometrial growths without damaging reproductive organs.
  • If pregnancy doesn’t occur after laparoscopic treatment, it may be recommended by your physician that you and your partner consider Assisted Reproductive Technologies (ARTs), specifically in vitro fertilization.  This option should be considered if endometriosis gravely affects your ovaries and/or fallopian tubes or if previous laparoscopic surgery was unsuccessful.

In Vitro Fertilization (IVF) is the most used ART in the event the fallopian tubes are blocked. Doctors treat you with a drug that causes your ovaries to produce multiple eggs. Once mature, the eggs are removed and put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted within your uterus.

ART procedures sometimes may involve donor eggs (eggs from another woman), donor sperm, or previously frozen embryos.

Donor eggs are sometimes used if you can’t produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus.

  • Other options -- Women with no eggs or unhealthy eggs might also want to consider surrogacy.

Women with ovaries but no uterus may be able to institute a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man's sperm and the embryo is placed inside the carrier's uterus.

It’s important to monitor your menstrual cycle and overall reproductive health for signs and symptoms of endometriosis, especially if you wish to become pregnant. Your local Capital Women’s Care team is here for you should you have any questions or concerns about symptoms you experience during your monthly menstrual cycles. Our family of healthcare professionals offers trustworthy, comprehensive care and screening to help you devise and institute a sound preconception healthcare plan should you wish to begin or expand your family.

For more information concerning endometriosis, contact:

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, HHS 800-370-2943

American College of Obstetricians and Gynecologists (ACOG) 800-673-8444

Endometriosis Association 414-355-2200

Endometriosis Research Center 800-239-7280


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