Patients often ask whether endometriosis can have an adverse affect on fertility. The short answer is, yes, it can.
While the reasons for this are not entirely understood, studies have shown that the more severe the endometriosis, the smaller the chance of a natural conception.
With minimal/mild endometriosis, the chances of becoming pregnant are only slightly below the healthy average; 75% against 84% after 1 year of trying. For sufferers of severe endometriosis, the difference is more stark, with only 25% of these women expecting to be pregnant after a year.
In moderate and severe cases the condition can cause an abundance of scar tissue (adhesions), which distort the anatomy of the pelvis and can cause issues by trapping the egg in the ovary thereby stopping it from reaching the fallopian tube.
For women with only mild endometriosis, the causes of a drop in fertility are less clear, and there has not been a definitive study to prove this definitively. However, a large Canadian study conducted in 1998 showed that surgical treatment of endometriosis sufferers improved the chances of a natural conception.
Deciding the right cause of action
One of the difficulties in deciding the right cause of action is determining whether someone is suffering with mild or severe endometriosis. The severity of the condition doesn’t always necessarily equate to the amount of pain a patient is experiencing.
The American Fertility Society Revised Classification of Endometriosis (AFS) score is a method of classification that divides sufferers into minimal, mild, moderate and severe stages. At the current time, laparoscopy offers the most detailed assessment, with the pelvis inspected and a score calculated based on the areas affected, as well as the degree of scar tissue and the presence of cysts on the ovaries.
So what can be done?
It is known that drug and hormone treatments for endometriosis do not improve fertility either during or after the course of treatment.
Generally drugs act against the hormones on which the endometrial tissues relies, with the aim of shrinking or stunting the growth of these lesions. Often these treatments act as a contraceptive, although they shouldn’t be relied upon as such as they could cause harm to an unborn baby.
Unfortunately, even if endometriosis is reduced or slowed by drugs and hormone treatments, fertility will not improve.
Surgical treatment through laparoscopy can both reduce pain and improve fertility. A Canadian study led by Dr Sylvie Marcoux studied 341 women aged 20 to 39 with minimal or mild endometriosis, who were experiencing problems with their fertility. The study compared the rates of pregnancy between a group which only received diagnostic laparoscopy, and a group which received laparoscopic excision surgery for their endometriosis.
In the surgically treated group 31% became pregnant within 36 weeks against just 18% in the diagnostic group.
Based on this study the view is that it would be sensible to continue trying to conceive naturally after surgery, allowing at least a year before beginning any fertility treatment.
Although endometriosis can cause a delay in getting pregnant, the pregnancy itself should not be any different from normal, in fact, generally, pain symptoms improve during pregnancy but may return as periods restart after giving birth.
Infertility is a complex and emotive subject which needs more than a blog post to consider properly.