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Monday, February 25, 2019

Endometriosis and infertility: help is available

by Dr. Jacqueline Kates

Woman holding S O S sign
In recognition of March as Endometriosis Awareness Month, let’s look at the causes and treatment options to increase fertility.

Endometriosis, a condition that affects up to 10 percent of women, exists when endometrial tissue, which typically grows inside the uterus, instead grows outside of the uterus. While some women with endometriosis have no symptoms, many women experience pain related to inflammation and scar tissue in the reproductive and other abdominal/pelvic structures. In addition to the pain and discomfort caused by endometriosis, between 30–50 percent of women with this condition also have trouble getting pregnant.

Endometriosis and infertility
While there is no one definitive mechanism that explains how endometriosis affects fertility, there are several possible ways that it can negatively impact fertility. Inflammation and adhesions in the pelvis can affect pelvic anatomy, essentially preventing eggs from effectively meeting with sperm in the fallopian tubes to allow fertilization. There are sometimes other associated issues that alter ovulation, the endometrium, or the ability to maintain a pregnancy. In addition, some women with endometriosis may find intercourse painful, particularly around the time of ovulation. While there is no cure for endometriosis, the good news is, there are options to help women with endometriosis become pregnant.

Every woman’s situation is different. The severity of endometriosis can vary from mild (stage 1) to severe (stage 4), which impacts symptoms and physical findings, and therefore treatment options. It’s important to talk to a knowledgeable health care provider about your specific symptoms, health status and goals so that you can work together to tailor a treatment plan.

In some cases, we can use medication to manage symptoms and improve the likelihood of a pregnancy. In others, surgical procedures can be performed to remove some of the tissue that may be impacting fertility in one way or another. While not a permanent solution, as the tissue often returns, these treatments can open a ‘window’ of opportunity for pregnancy to occur. Assisted reproductive techniques, such as in-vitro fertilization (IVF) or intrauterine insemination (IUI), along with fertility medications can also be effective. In many circumstances, we use a combination of management strategies.

If you need help managing your endometriosis, or are having trouble getting pregnant, call us for an appointment. We’ll talk with you about your options, and work with you to decide next steps.