Getting pregnant with endometriosis: Risk and Possibilities

About 10% of the reproductive age women suffer from endometriosis. Endometriosis is a chronic condition where the endometrial tissue which lines the uterine cavity is found outside the uterine cavity. It can be found in the uterine muscles when it is called adenomyosis, in the ovaries, ligaments, pouch of Douglas i.e. the most dependent cavity in female body, in the tissue between vagina and urinary bladder, between vagina and rectum, cervix , vagina ,infiltrating in the rectum. It can also be found outside your pelvis in the brain, liver , lungs , and scar. This ectopic endometrial tissue induces an estrogen dependent inflammatory reaction which causes all the symptoms of endometriosis.

Why does endometriosis cause infertility?

30 to 50% of women with endometriosis find it difficult to conceive. 25 to 30%of infertile women suffer from endometriosis.

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According to the American Society for Reproductive Medicine ASRM endometriosis affects fertility in following ways:

• Distorted pelvic anatomy
• Ovulatory dysfunction
• Altered peritoneal function
• Altered hormonal and cell mediated functions in endometrium 

Let us have a look in some of the causes in detail:

Ovulatory dysfunction 

One of the commonest sites to find endometrial tissue is ovaries. Cyclical bleeding causes haemorrhage and collection of blood which enlarges over a period of time to form large endometriosis also called as chocolate cysts (chocolate coloured fluid which is the old blood in the cyst). This affects the number of eggs in the ovary and also the quality of the eggs. The altered anatomy and the hormonal content affects the process of ovulation and leads to luteinized unruptured follicle syndrome i.e. mature eggs are formed but not released.

Ovary produces progesterone after release of egg but due to defective ovulation progesterone production is affected causing luteal phase defect which prevents proper implantation of fertilised ovum.

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Inflammation

Inflammation is the body's natural response to injury or infection. The endometriotic lesions also induce inflammation which leads to formation of scar tissues and adhesions. Adhesions are scar tissue bands connecting two organs which are normally not connected to each other. This distorts the anatomy . The fallopian tube may not be able to pick up the egg , the transport of egg inside the tube may get affected , the fertilisation process which happens in the tube will also be affected. Endometriosis does more to your body than just causing pelvic pain.

How can one get pregnant with endometriosis ?

Medical management of endometriosis leads to suppression of ovaries and will hamper fertility. Surgical intervention is required for patients wanting to have babies.

Surgical intervention like laparoscopic excision i.e. removal of the endometriotic implants helps to improve fertility. However if ovaries are involved then there are chances of reduced ovarian reserve post surgery or even loss of ovary if the surgery needs that.

In advanced cases the main aim of surgery is to restore the anatomy which may help to enhance fertility. In case of loss of tubular function,male infertility or any other additional cause for infertility,IVF with embryo transfer is the better option of treatment.

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However there are still some patients who have conceived naturally with endometriosis. But do not keep waiting too long for natural conception. It is always better to ask for help in time.