Endometriosis and Infertility

Endometriosis is one of the most common female reproductive disorders affecting approximately 40% of all patients with infertility. Endometriosis is typically associated with pelvic pain, particularly with pain around the time of menstruation. Endometriosis, however, can also be a profound cause of infertility.

Endometriosis is defined as normal endometrial tissue, which typically belongs in the uterine cavity, growing outside of the uterus. It is typically found behind the uterus, around the fallopian tubes and occasionally in the ovarian tissue itself. There are many theories regarding the cause of endometriosis. The most common cause appears to be regurgitation of menstrual fluid through the fallopian tubes which occurs in the majority of women. In those women with endometriosis, there appears to be a segmental defect in the autoimmune system which allows this tissue to grow outside of the uterus. The resulting inflammation from the endometrial tissue causes damage to eggs and sperm during the reproductive process.

The only way to officially make the diagnosis of endometriosis is through a laparoscopy and biopsy of the tissue. Studies in 1998 and 1999 in Canada and in Italy both demonstrated that laparoscopy does not result in a significant improvement in fertility for those women with infertility from endometriosis. This appears to be due to the fact that only approximately 20% of endometriosis can be seen during surgery while the remaining 80% is deep behind tissues and not easily visualized.

It is estimated that the monthly pregnancy rate for a fertile couple at 35 years of age is approximately 20% if they don’t have any reproductive abnormalities. Patients with mild to moderate endometriosis have been noted to have a 3% to 4% chance of pregnancy per month and those with severe endometriosis a 2% to 3% chance of pregnancy per month. Simple forms of treatments such as ovulation induction and intrauterine insemination result in a modest improvement in pregnancy rates in those patients with endometriosis, most likely from an increase in the number of eggs which are ovulated.

The more involved process of in vitro fertilization appears to have the biggest impact on patients with endometriosis. In vitro fertilization involves creating multiple eggs and physically removing those eggs from the environment of the endometriosis prior to ovulation. The sperm is then mixed with the eggs in a test tube creating an embryo, and then the embryos are ultimately placed back into the uterine cavity which has normal endometrial tissue in the normal location. The national data shows that women with endometriosis undergoing treatment with IVF have the same pregnancy rates as those women without endometriosis.

If you are concerned about the possibly of having endometriosis, we recommend you seek the care of your Gynecologist or a Reproductive Endocrinologist for an assessment and treatment options. If there’s any way we can be of assistance at Coastal Fertility Specialists please feel free to contact us at 843-883-5800.