Endometriosis & infertility: What are my options?

Endometriosis (pronounced en-doe-me-tree-oh-sis) is a very common condition, affecting around 1 in 10 women in the U.S. The condition can cause not only pain and internal scarring, but also infertility.

Because pain is the most common symptom, many dismiss the discomfort as just a bad menstrual period. 

Unfortunately, that means that many endometriosis cases aren’t actually diagnosed until it’s time to start a family, and patients find themselves unable to get or stay pregnant.

But what is endometriosis, and how does it affect fertility?

Endometriosis is a disease of the uterine lining.

For patients with endometriosis, tissues in the body that are outside of the uterus go rogue, and act as the uterine lining (endometrium) would: they thicken, then bleed along with your regular period. But with no exit to leave the body, this blood can collect and cause irritation — and eventually scarring. 

These tissues can be anywhere in the body: the ovaries, fallopian tubes, and even intestines (in severe cases), causing pain and even scarring of the organs. 

Endometriosis has four stages:

Stage I (minimal) can mean there are a few small small implants or lesions around or outside your uterus, and there’s little to no scar tissue. This stage often presents with the fewest symptoms, so many cases go completely undiagnosed. 

Stage II (mild), like Stage I, can present with very few symptoms, or the symptoms of a bad period. This stage is classified as having more implants than Stage I that are deeper in the tissue of the organs, and can include some scarring.

Stage III (moderate) is categorized as including all criteria for the first two stages, but there is also the presence of endometriomas, or “chocolate cysts” in the ovaries, which can severely impact fertility.

Stage IV (severe) includes all the findings from the first three stages, but far more widespread. The lesions and scar tissue are larger and severely disrupt the function of the reproductive organs. Conditions at this stage usually make natural contraception very unlikely.

Lesions and scarring interrupt the natural conception process.

Endometriosis can cause lesions and scarring within the ovaries, fallopian tubes, and uterus, keeping the egg from travelling and embedding in the uterine lining. In addition to causing pain and irritation, this can make it difficult to conceive and/or successfully carry a baby to term. 

Treating the endometriosis can also impact a patient’s natural fertility.

Hormonal birth control, for instance, is often prescribed to endometriosis patients as a means of controlling the discomfort. This prevents conception, so patients starting a family must go off of the medication.

Surgery is also often suggested to improve pain symptoms for patients with endometriosis. Unfortunately, the relief may not last. Repeated surgeries involving the ovary can also diminish your egg reserve.

Fertility treatment options for patients with endometriosis:

If endometriosis is impacting your fertility, in vitro fertilization (IVF) typically offers the best chance for success, especially in those with moderate to severe cases. 

Since endometriosis can deplete the egg reserve in the ovaries more than regular menstruation, IVF can both help couples conceive now, or extract eggs and freeze them for the future. 

For patients with endometriosis, effortless IVF® is also an option. This procedure is about half the cost of traditional IVF, with similar success rates, thanks to the revolutionary INVOcell device.

It’s also more natural and convenient for patients, with a streamlined medication protocol and fewer appointments required. 

Choosing IVF can also help reduce the number of “natural” menstrual cycles you have to experience before you conceive, since trying to conceive means going off of your pain-saving birth control.

Your doctor can diagnose endometriosis and recommend a treatment plan.

Most endometriosis cases can be diagnosed with a regular doctor’s visit, but the ‘gold standard’ for diagnosis is through laparoscopic surgery. Not to worry! This procedure is minorly invasive and can give great insight into what may be affecting your family plans.

Though it may be unexpected or scary, an endometriosis diagnosis is often a vital step towards feeling better and building your family. It can provide validation to patients who endured years of pain that was written off as “just a bad period,” and it provides patients and their doctors with a clear path for treating their discomfort and their infertility.

Even if you have confirmed endometriosis, that may not be the only factor in your infertility. 

Female infertility factors are responsible for about a third (33%) of all infertility cases, so there could be other factors at play, including a male factor. 

Therefore, it’s important that both you and your partner get evaluated by a reproductive endocrinologist to get to the bottom of what’s causing your fertility issues.

Every patient's story and medical history is unique. 

If you’re having issues conceiving and either have or suspect you may have endometriosis, your best next step is to make an appointment with a fertility doctor, who can diagnose you and help you understand your options.

And with all initial consultations taking place via telehealth (phone call or Zoom), it's never been easier to get started.

When you’re ready, call 817-540-1157 or click on "New Patient Paperwork" from the menu.