Pregnancy FAQ

Endometriosis: The Impact on Fertility and Pregnancy

Pain of Endometriosis

Introduction

Endometriosis is a chronic and often painful condition affecting millions of women worldwide, often leading to significant challenges in fertility and pregnancy. It occurs when tissue similar to the lining inside the uterus, known as the endometrium, starts to grow outside the uterus. However, its impact on fertility is one of the most profound concerns for women who hope to conceive. In this article, we’ll explore how endometriosis influences infertility, pregnancy outcomes, and the available treatment options to help manage this condition.

What is Endometriosis?

Endometriosis is a condition in which the tissue that normally lines the inside of the uterus grows outside it, often on the ovaries, fallopian tubes, and the tissue lining the pelvis. However, endometrial-like tissue can also be found beyond the pelvic organs. This displaced tissue continues to act as it normally would—it thickens, breaks down, and bleeds with each menstrual cycle. Because this tissue has no way to exit the body, it becomes trapped, leading to inflammation, cyst formation, scar tissue, and adhesions. Diagnosis is usually confirmed by laparoscopy (a telescope like instrument is inserted into the body through a small “keyhole” incision). This is not always straightforward. Imagine a bowl of spaghetti, add a few grains of black pepper then stir it up. Now insert a telescope and look around. If you see black specs, you can confidently say – “there is black pepper here”. If you don’t see any you cannot say “there is none there!” My specialty was Gynaecological Endocrinology and Infertility – as a tertiary referral unit we accepted patients from Gynaecologists not GPs. Often a patient would arrive with a classical history of Endometriosis, the accompanying referral saying that a laparoscopy had been done and there was no Endometriosis. We would repeat the laparoscopy and find Endometriosis.

How Endometriosis Affects Fertility

One of the most significant impacts of endometriosis is on fertility. The condition is known to cause infertility in about 30-50% of women who are diagnosed with it. Here’s how endometriosis can interfere with fertility:

  • Blocked Fallopian Tubes: Scar tissue and adhesions can block the fallopian tubes, preventing the egg from meeting the sperm. Even partial blockages can hinder fertilization, increasing the time it takes to conceive or leading to infertility.
  • Ovarian Function: Endometriosis can interfere with ovulation, making it difficult for the ovaries to release healthy eggs. Inflammation caused by the condition may also damage the eggs or the ovarian reserve, reducing fertility over time.
  • Inflammation: The inflammation caused by endometriosis can lead to an environment in the pelvic area that is hostile to both sperm and eggs, reducing the chances of fertilization.
  • Impaired Implantation: Even if fertilization occurs, the environment inside the uterus is crucial for implantation. Endometriosis can disrupt the normal uterine lining, making it harder for an embryo to implant successfully, thus reducing the chances of pregnancy.

Endometriosis and Pregnancy: What You Need to Know

Women with endometriosis who do conceive may still face challenges during pregnancy. The condition has been associated with an increased risk of several complications:

  • Miscarriage: Studies suggest that women with endometriosis have a higher risk of miscarriage compared to those without the condition.
  • Preterm Birth: There is also an elevated risk of preterm birth, where the baby is born before 37 weeks of pregnancy, which can lead to health issues for the newborn.
  • Placenta Complications: Endometriosis can increase the risk of placenta previa (where the placenta covers the cervix) and placental abruption (where the placenta detaches from the uterus before delivery).
  • Caesarean Delivery: Women with endometriosis are more likely to require a caesarean delivery due to complications during pregnancy or labour.

Treatment Options for Endometriosis-Related Infertility

  • Medication   Hormonal therapies, such as birth control pills, GnRH agonists, and progestins, can help manage endometriosis symptoms, though they don’t address infertility directly. These treatments may be used before attempting to conceive to reduce symptoms. I used to prescribe Danazol for Endometriosis treatment. Unfortunately, it has largely been abandoned because of potential side effects – nausea and vomiting and androgenic effects – acne and facial hair growth. According to the literature a large number of patients stopped treatment because of these side effects. This was not my experience. I prescribed starting dose at one quarter of the recommended dose slowly building up – this way, side effects were not an issue. A patient with a history of severe abdominal and pelvic pain, was found to have multiple tumours and was operated on expecting cancer. At laparotomy a section was sent to the laboratory and reported as Endometriosis. The abdomen was closed with no further surgery and the patent transferred to my care. I started her on Danazol and at laparoscopy 6 months later, the abdomen and pelvis were completely clear.
  • Surgery Laparoscopic surgery is a common approach to remove endometriosis lesions, scar tissue, and adhesions. This should only be done by a Gynaecologist who specialises in laparoscopic surgery. Operating around the fallopian tubes (micro-tubal surgery) using needles finer than a human hair is a highly skilled technique. Also operating on any tissue can potentially produce more scar tissue and adhesions.
  • Assisted Reproductive Technologies (ART) For women struggling with infertility due to endometriosis, ART options like in vitro fertilization (IVF) may offer a higher chance of conception. IVF bypasses many of the fertility obstacles caused by endometriosis, allowing for egg retrieval, fertilization, and embryo implantation in a controlled environment.

Conclusion

Endometriosis is a complex condition that presents significant challenges to fertility and pregnancy, but with the right management strategies, many women can still achieve their dream of having a family. From early diagnosis to tailored treatment plans, understanding the condition is the first step towards better reproductive outcomes. If you suspect that you have endometriosis or are struggling with infertility, consult a healthcare provider to explore your options.

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