Everything You Need to Know about Endometriosis and Fertility

The first thing that concerns every woman with endometriosis is if they can conceive naturally and the various effects of the disease related to fertility. Here are some of the factors which explain how the disease affects fertility in women. 

Since the uterus, tubes, and ovaries may be stuck to each other and various organs and structures around them, the anatomical relationship between the tube and the ovary may be lost. The job of the fallopian tube is to pick up the egg from the ovary however, that is only possible if the end of the tube is sweeping over the surface of the ovary. If this relationship is lost, then the egg doesn’t enter the fallopian tube and thus cannot meet the sperm.

The active endometriotic tissues release a certain chemical that sort of eats up or destroys the sperm or the egg or both or the resulting embryo. 

Lastly, the walls of the uterus can be invaded by adenomyosis and this prevents the embryo from attaching to the walls which is a necessary event to get pregnant. 

Dealing With Endometriosis While Planning For Pregnancy

Fertility with endometriosis needs serious consideration since it decreases with this disease. Getting pregnant can be a problem for some women with endometriosis. 

Treatments that were effective for pain management don’t work in infertility with endometriosis. Treatment mainly depends on the stage of the disease and some other factors:

  • Age of the woman
  • Status of the ovarian reserve 
  • Whether fallopian tubes are open or blocked and lastly
  • Male partner’s sperm parameter reports 

You need very careful planning after the initial evaluation considering all of the above factors. 

This is the most important stage. Overtreatment is fine, however, under-treatment is not.  In endometriosis, the insides of the tummy are in a bad shape and the tissues and organs are stuck to each other. However even then, if doctors test the fallopian tubes, many times the fallopian tubes are open. This is confusing for both doctors and patients into thinking natural conception is possible. 

Natural conception is more likely in the early that is stage 1 of the disease. There are algorithms that doctors use after staging the disease via laparoscopy. These algorithms or formulas tell us the probability of natural conception in one year following the staging laparoscopy.

The problem is, you cannot discover stages 1 and 2 of the disease without laparoscopy.  Therefore, even with symptoms, unless one is very alert about endometriosis they realise only when the disease is more advanced. However, while one waits, we must remember that this is a progressive disease and algorithms guide but don’t guarantee.  Moreover, as the disease further progresses, fertility goes down.

Is it possible to conceive naturally for women dealing with endometriosis?

Factors like age, sperm quality, etc can determine if women can conceive naturally with endometriosis. If all is normal then doctors suggest trying for 3 months however under strict supervision. If that doesn’t work doctors usually suggest they move to IUI immediately. 

The next level of treatment is through IUI or Intrauterine insemination. Doctors won’t dwell on the details of this treatment as it is worthy of a complete podcast by itself. But in a nutshell, the process involves creating a controlled environment wherein doctors give the woman tablets and injections to make good quality and numbers of eggs, and monitor the growth of follicles containing the eggs.

This helps them to know the right time to perform the IUI, and process the man’s semen sample to remove the bad sperms and make the good sperms even better. Then finally the sperm are dropped inside the uterus with the help of a thin catheter. It takes just 2 minutes and is a completely painless procedure. This treatment is possible Only if the disease is in Stage I or II is IUI possible. 

If the disease is extensive and in Stage III or IV, IVF is a better treatment to undertake as the pregnancy rates are better.

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