ARC® Fertility Articles

Endometriosis and Fertility

James Douglas, M.D.©
IVF Plano
6300 W. Parker Rd. #G28
Plano, TX 75093

A condition affecting 5 million American women, endometriosis derives its name from the word endometrium, the lining in the uterus that your body produces each month in case of egg implantation. If conception does not take place during a given month, then your body will shed the endometrium and a menstrual period will occur.

Sometimes, this endometrial tissue travels out the end of the fallopian tube and into the abdomen. In some women, the tissue will attach to other organs. The hormones made in the next menstrual cycle stimulate this extra tissue to grow and later shed just like the tissue in the uterus. However, this bleeding and tissue shedding has no way to exit the body, which causes inflammation and irritation of local tissue. Usually, the inflammation causes the pain that patients often experience with endometriosis.

Symptom of Endometriosis

Common symptoms of endometriosis include discomfort before and during menses, painful intercourse, infertility, pain or other abnormalities with urination or bowel movements around the time of menses break through bleeding between menses, and fatigue, as many as 15 to 20 percent of women with endometriosis will present with no symptoms. Some women with endometriosis may also have other immune disorders such as asthma, eczema, and fibromyalgia. With endometriosis, the amount of pain or number of symptoms doesn’t correlate with the severity of the endometriosis. Some women, for example, have mild endometriosis and severe symptoms, while others have severe endometriosis and no symptoms.

Impact on Fertility

The inflammation and irritation caused by the endometriosis can affect fertility. Inflammation of the fimbria, which pick up the egg and transport it into the fallopian tube, causes swelling and scarring so the egg may not reach its destination. As well, the inflammation damages the sperm and eggs when they are exposed to the inhospitable environment caused by the endometriosis. In more advanced cases, the endometriosis starts to cause adhesions, and the pelvic organs become stuck to each other, resulting in decreased function. Endometriosis can also block the fallopian tubes.

Unless the endometriosis has formed a cyst on the ovary called an endometrioma, which can be seen with a sonogram, your doctor can only make the diagnosis with laparoscopy. This minor outpatient surgery involves the insertion of a scope through the umbilicus and into the abdomen. During the laparoscopy, your physician can treat any endometriosis with cauterization, laser, or scissors to remove the lesions.

Pregnancy and Endometriosis

Fortunately, pregnancy actually improves endometriosis. The hormones produced cause most of the endometriosis to resolve, so our team tries to help women conceive prior to performing laparoscopy. When the endometriosis is so severe that conception does not happen, then a laparoscopy is necessary. After surgery, the best chances of conceiving are during the first few months following the procedure. Once conception has occurred and most of the endometriosis has resolved, your doctor can take steps to prevent the endometriosis from reoccurring. Breast feeding slows the growth of endometriosis as do birth control pills. Once a patient finishes breast feeding, we recommend starting birth control pills until she wants to conceive again. This plan will offer the best chances for conceiving without having to endure laparoscopy again and any other infertility treatment.

©James Douglas