Endometriosis and Fertility

Endometriosis is a condition where cells similar to those making up the lining of the uterus are found in other parts of the body, commonly the ovaries or fallopian tubes, but it could also occur in other areas.

Despite these cells growing in other areas of the body, they still react in the same way as they would in the uterus. Hormones are naturally released in a woman's body, causing the uterine cells to build up each month and form a thick uterine lining for potential pregnancy and then breaking down and bleeding if a pregnancy does not occur. However, whereas the cells in the womb will leave the body as a period, for the cells in other areas of the body, the blood has no way of leaving and will remain in the body.

This build up of blood can lead to inflammation, pain and the formation of scar tissue. It can also lead to very painful or heavy periods and can be debilitating for some.

Unfortunately, it is extremely common and effects around 1.5 million women in the UK alone. The exact cause is unknown and any women of childbearing age could be affected. There are a number of theories as to why it occurs, and it is assumed that a range of factors normally play a part, including a genetic predisposition and environmental factors.

Endometriosis can lead to:

  • Chronic pain; during periods, during ovulation or after sex

  • The pain can include lower abdomen pain, pelvic pain, back pain, leg pain

  • Heavy and/or prolonged bleeding, bleeding or spotting between periods

  • Bowel and bladder problems, including bleeding bowel or pain when passing urine

  • Fatigue/lack of energy

  • Infertility

Endometriosis has historically been hard to get diagnosed (average of 7.5 years from first GP appointment!) as the symptoms have often not been taken seriously by the medical profession or have been explained away as something else. Fortunately this is beginning to change, more research is being done and more people are getting referred for treatment. If you are still struggling to get a diagnosis and believe you are suffering with the condition, it is recommended that you keep pushing for further testing. Your doctor will usually feel the abdomen area and carry out ultrasounds, but the condition can only really be confirmed by having a laproscopy which involves a small camera being inserted into the pelvic area.

Endometriosis ranges from minimal to severe which is based on how much tissue has grown and where it is in the body, and doesn't necessarily relate to how much pain you feel. Treatment for endometriosis depends on the severity of the symptoms and how much it is affecting your life.

Endometriosis can have an effect on your fertility and although the link is not fully understood, it is likely due to the adhesions or scar tissues changing the anatomy of reproductive system, for example blocking the fallopian tubes and disrupting the natural conception cycle. For women with minimal or mild endometriosis it is thought that their fertility is unaffected by the condition, however, for those with moderate to severe endometriosis it is expected their chances of conceiving naturally will be reduced.

If you have endometriosis (even if only minimal or mild) or suspect that you might do, and you are struggling to conceive treatments are available, with surgical treatments being the most beneficial for improving fertility. During the laproscopy which diagnoses the condition, it is possible to remove the adhesions or nodules in this same procedure. There is another form of surgery to remove the unwanted tissue, called a laparotomy, which is more invasive and is therefore only carried out in a few exceptional circumstances. Both procedures should help to clear the reproductive system to enable it to function in a more optimal way. After surgery, endometriosis can reoccur at an average rate of 50% over 5 years.

Anecdotally women have reported an improvement in their endometriosis and ability to conceive through improving their diet and/or having complementary therapies but no scientific evidence has yet proved the effectiveness and it will vary from person to person. However, to have a healthy diet, good water intake and reduced stress levels are factors that will improve your mental well-being in order to support you through your conception and pregnancy journey.

Fertility treatments such as IVF or IUI ( Intrauterine Insemination) are commonly used for endometriosis-related infertility. NICE recommends that IVF is offered after two years of unsuccessfully trying for a baby with endometriosis, assuming other factors affecting fertility are normal. Success rates, as with all fertility treatments, will vary, and more severe endometriosis may reduce your risks further.

If you are concerned that endometriosis may be affecting your ability to conceive, see your GP and make sure that it is fully investigated. You know your own body and your doctors should offer you the help and support you need.

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