Endometriosis and Infertility
Endometriosis is a common but complex medical condition that affects women of reproductive age. Along with symptoms such as pelvic pain and painful periods, endometriosis can impact fertility. Studies show that up to half of women with endometriosis have trouble getting pregnant.
Fortunately, with proper diagnosis and treatment many women with endometriosis can successfully conceive.
At Generations Fertility Care, our doctors share a special interest in helping women with endometriosis become pregnant. Our patients include women who have managed their endometriosis symptoms for years and are ready to start a family. We also see women who have been unable to get pregnant and find out they have endometriosis after infertility testing.
Regardless of your circumstances, you'll receive care in a warm and supportive environment from fertility specialists who have experience treating even the most challenging cases of endometriosis.
What is endometriosis?
Your uterus is lined with a special tissue, called the endometrium, that plays an important role in menstruation. Over the course of a normal menstrual cycle, the endometrium thickens and thins. It eventually breaks down and exits the body as part of your monthly menstrual flow, or period.
In women with endometriosis, endometrial tissue grows outside of the uterus in the ovaries, fallopian tubes and other areas within the pelvis. This abnormal tissue behaves just like a healthy endometrium - it thickens and thins, then eventually breaks down. But because this displaced tissue cannot exit your body, it builds up and can cause scarring and other problems.
Endometriosis often develops several years after you begin menstruating and can continue through menopause. Symptoms go away during pregnancy, but they usually return once you give birth and have regular periods again.
Symptoms of Endometriosis
The most common symptom associated with endometriosis is pain, including:
- Painful periods
- Pain in the lower abdomen or lower back that can begin a week or two before menstruation
- Pain during or after sexual intercourse
- Pain with bowel movements, especially during your period
Even though pain is a common symptom, it is not a reliable indicator of the severity of your condition. Some women with advanced endometriosis never experience pain and are not aware they have it. Others with mild endometriosis report frequent or intense pain.
Other symptoms of endometriosis include:
- Premenstrual spotting
- Unusually heavy periods, or bleeding between periods
- Gastrointestinal problems such as bloating, constipation or diarrhea, especially during your period
- Problems getting pregnant
How does endometriosis affect fertility?
When endometrial tissue builds up inside your body, it can disrupt the normal reproductive process. For example:
- Fluid-filled cysts called endometriomas may form in your ovaries. These cysts can rupture, damaging your ovarian tissue or interfering with ovulation.
- Scar tissue can block one or more of your fallopian tubes. This makes it impossible for sperm to reach an egg released by your ovary.
- Fertility naturally decreases with age, even in healthy women. If you are older than 30 or have diminished ovarian reserve, having endometriosis can make it that much harder to get pregnant.
Risk Factors for Endometriosis
Doctors and scientists have made important advances in diagnosing and treating endometriosis, but they still don't know what causes it. However, certain factors appear to put you at greater risk for developing endometriosis. These include:
- Having a relative, especially a mother or sister, with endometriosis
- Starting menstruation at an early age
- Having shorter, more frequent menstrual cycles (less than 27 days in length)
- Having periods that last longer than seven days
- Having a low body mass index, or BMI
- Producing higher-than-average amounts of estrogen in your body
- Regularly consuming alcohol
How is endometriosis diagnosed?
If your doctor suspects you have endometriosis, he or she will perform one or more of the following tests:
- A pelvic exam. During this physical examination, your doctor will examine your internal reproductive organs. He or she will see if they can feel any abnormalities, such as cysts or scar tissue.
- A pelvic ultrasound. This common imaging test uses an ultrasound wand to produce pictures of your reproductive organs. It is used to look for cysts or other abnormal masses associated with endometriosis.
- Laparoscopy. While other tests can help detect signs of endometriosis, the only way to absolutely confirm it is through a minimally invasive surgical procedure called laparoscopy. During the procedure, which requires general anesthesia, your surgeon will insert a tiny camera into your abdomen through a small incision near your belly button. He or she will examine your reproductive organs for evidence of endometriosis. They can also take tissue samples for further examination.
Treatment Options for Endometriosis
There are a variety of medical and surgical treatment options for endometriosis. Some are used simply to help you manage your symptoms. Others can also increase your chances of getting pregnant in the future. Treatments include:
Over-the-counter pain relievers, including ibuprofen and nonsteroidal anti-inflammatories (NSAIDS), may help reduce menstrual pain or general pelvic pain.
Prescription hormone drugs can help prevent endometrial tissue from growing and spreading. In turn, this can reduce the pain caused by endometriosis. Hormone therapies include:
- Continuous cycle contraceptives, including birth control pills, patches and vaginal rings.
- Progestin-only contraceptives, including implanted intrauterine devices (IUDs) or contraceptive injections (shots).
- Gonadotropin-releasing hormone (GnRH) agonists and antagonists, drugs that lower estrogen levels in your body, shrink endometrial tissue and prevent you from having periods.
These therapies help control your condition until you are ready to get pregnant, at which time you will stop taking them.
Surgery to treat endometriosis can be minimally invasive (laparoscopic) or traditional "open" surgery. During surgery, your doctor may remove cysts or other lesions from your reproductive organs. Surgery can also help relieve severe pain.
We are one of the few health care providers in Wisconsin offering laparoscopic excision, a highly effective treatment for endometriosis.
Assisted reproductive technology
Some women who have medical or surgical treatment for endometriosis still need help getting pregnant. Other women prefer not to have surgery, and opt for less invasive ways to try and conceive.
For patients with endometriosis, assisted reproductive technologies may further improve your chances of getting pregnant. These include:
- Intrauterine insemination, or IUI, which may be combined with ovulation induction medications.
- In vitro fertilization, also known as IVF. Learn more about our IVF success rates, which are consistently above the national average.
Together, you and your provider will determine which procedure is best for you. Success depends on several factors, including your age and the severity of your endometriosis.
Learn More About Endometriosis
Living with endometriosis can be challenging enough without added worries about infertility. Let us ease your concerns about getting pregnant and help you manage your symptoms along the way.
If you have questions about infertility or endometriosis, or are ready to schedule an initial appointment, please call (608) 824-6160 or complete our online form.