“Endometriosis is a painful gynecological condition affecting over 190 (19 crores) million girls and women globally. India alone represents 25 percent of the burden with an estimated 43 million (4.5 crores) women enduring the pain suffering from Endometriosis which is a leading cause of infertility as well” said Dr. Vimee Bindra, Robotic and Laparoscopic Surgeon, Fertility Enhancing Surgery Specialist; Endometriosis Excision Surgery Specialist;  founder of Endometriosis Foundation of India.

Approximately one-third of the women suffering from endometriosis can face some difficulty in conceiving. However, there are many others too with mild endometriosis who do not face any issues with fertility. These issues are more likely to develop as a woman moves towards a severe endometriosis case.

For a woman to become pregnant, her ovary must release an egg and that must travel through the fallopian tube. The egg is then fertilized with a sperm and attaches itself to the wall of the uterus to begin the development of the fetus. In Endometriosis, the fallopian tubes may be blocked or damaged which prevents the sperm and the egg from coming together. In some cases, endometriosis can damage the egg in the ovaries which may lead to lowered ovarian reserve and even low egg quality and quantity.

How do I know if I have endometriosis?

Endometriosis may present as painful periods, pelvic, and abdominal pain, irregular bleeding, painful sex, and infertility or it may be asymptomatic in some cases. As it involves the pelvic organs and pelvic peritoneum, it causes infertility in 30-50% of women. For some women, there may be a formation of an ovarian cyst called a chocolate cyst which can be picked up on ultrasound. A good clinical history and examination are the key to diagnosing endometriosis and then comes the role of imaging and laparoscopy. 

Common symptoms of endometriosis are 

       Very painful menstrual cramps 

       Chronic pelvic pain, backache

       Painful sex

       Painful defecation/urination 

       Bleeding or spotting 

       Infertility 

       Stomach /digestive problems simulating idiopathic Bowel Syndrome (IBS) 

       Diarrhea and constipation

       Fatigue

       Depression 

How endometriosis causes infertility?

Endometriosis impacts fertility through various mechanisms such as 

       It distorts the pelvic anatomy

       Adhesions 

       Scarring 

       Tubal damage 

       Inflammation of pelvic organs 

       Affects the egg quality 

       Interferes with implantation 

       Changes in the hormonal milieu 

Different treatment modalities for endometriosis-related infertility?

Your doctor may offer one of these treatment modalities depending on your requirements, age, and extent of disease.

       Freezing your eggs: some doctors may recommend freezing your eggs in case you wish to become pregnant later as endometriosis decreases ovarian reserve. 

       Superovulation and IUI – may be an option for women with mild endometriosis, with patent tubes, and whose partner has good-quality sperm. 

       Fertility medications such as Letrozole and Clomiphene may be prescribed 

       Regular ultrasounds to ensure egg maturity and timing of IUI

       Advanced options such as IVF, and ICSI for moderate to severe endometriosis or women who have not responded to other treatments.

 How can I improve my chances of getting pregnant with endometriosis?

It is important to live a healthy lifestyle which includes an anti-inflammatory diet and pelvic exercises which help by reducing inflammation in your body. 

       Maintain a healthy weight 

       Eating a well-balanced diet 

       Moderate exercise 

Fertility treatment success is age-dependent. Higher fertility is seen in the younger population and women aged above 35 years are at greater risk of infertility as well as miscarriage.

About the author- Dr. Vimee Bindra