Endometriosis and Infertility

Endometriosis is a disease in which tissue similar to the lining of the uterus grows outside the uterus. It can cause severe pain in the pelvis and make it harder to get pregnant. It often affects the ovaries, fallopian tubes, and the tissue lining the pelvis. Rarely, endometriosis growth may be found beyond the area where pelvic organs are located.

Endometriosis can start at a person’s first menstrual period and last until menopause.

Endometriosis is a condition that most commonly affects people between the ages of 25 and 40. It can also happen to younger people during their teenage years. Although symptoms of endometriosis often improve after menopause, it can still cause discomfort and pain.

Endometriosis symptoms can vary greatly from woman to woman, ranging from severe to mild or even asymptomatic. Key signs of endometriosis include:

• Painful Periods: Intense menstrual cramps that may begin before the period and last several days. Pelvic pain and cramping can also extend to the lower back and abdomen.
• Painful Intercourse: Discomfort or pain during or after sexual intercourse, often described as deep rather than superficial.
• Pain During Bowel Movements or Urination: Painful bowel movements or urination, especially during menstrual cycles, which can be debilitating.
• Excessive Menstrual Bleeding: Heavy menstrual periods (menorrhagia) or bleeding between periods (menometrorrhagia) are common in women with endometriosis.
• Other Symptoms: Fatigue, diarrhea, constipation, bloating, and nausea, particularly during menstrual periods. These gastrointestinal symptoms can sometimes be confused with conditions like irritable bowel syndrome (IBS).

Regardless of their social standing or cultural background, endometriosis is a complicated illness that affects a large number of women worldwide from the time of their menarche until menopause. Its development is thought to be influenced by various factors. Currently, endometriosis is believed to develop as a result of:

• Retrograde Menstruation: Menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity instead of leaving the body, leading to implantation and growth of these cells outside the uterus.
• Embryonic Cell Transformation: Hormones such as estrogen may transform embryonic cells into endometrial-like cell implants during puberty.
• Surgical Scars: After surgeries like hysterectomy or C-section, endometrial cells can attach to surgical incision sites.
• Hormonal Imbalance: Higher levels of estrogen, a hormone that is responsible for the growth of endometrial tissue, may promote endometriosis.
• Genetic Factors: Genetic predisposition may make some women more likely to develop endometriosis.

The development or survival of ectopic endometrial tissue may also be influenced by additional variables. For instance, it is well-recognized that endometriosis is estrogen-dependent and that this boosts the disease’s progression, inflammation, and discomfort. The complex association between endometriosis and estrogen is because endometriosis is not always present in the absence of estrogen.

Endometriosis is a prevalent factor in infertility, impacting up to 50% of women having trouble conceiving. This condition affects fertility through several mechanisms:

1. Fallopian Tube Blockage: Endometrial tissue growth on the fallopian tubes can obstruct them, hindering the passage of eggs from the ovaries to the uterus and thereby impeding fertilization.
2. Pelvic Adhesions: Scar tissue or adhesions may develop due to endometriosis, altering the structure of pelvic organs. This structural change can make it challenging for eggs and sperm to meet, affecting fertility.
3. Ovarian Function: Endometriosis can lead to the formation of cysts called endometriomas on the ovaries. These cysts can damage ovarian tissue, compromising both the quality and quantity of eggs.
4. Inflammation: Endometriosis triggers inflammation in the pelvic area. This inflammation can disrupt the function of the ovaries, fallopian tubes, and uterus, complicating the processes of fertilization and embryo implantation.
5. Immune System Dysregulation: Endometriosis can also impact the immune system, potentially leading to an immune response against embryos and making implantation more difficult.

A detailed medical history focusing on persistent pelvic pain and menstrual symptoms forms the basis for suspecting endometriosis. While several screening instruments and tests have been developed and evaluated, none of them have been proven to reliably detect or predict the individuals or groups that are most likely to have the illness. Endometriosis frequently exhibits symptoms similar to those of other illnesses, delaying diagnosis. Ultrasonography or magnetic resonance imaging (MRI) is often needed for the detection of ovarian endometrioma, adhesions, and deep nodular types of illness. To establish the diagnosis, histologic verification—after surgical or laparoscopic visualization—can be helpful, especially for the most prevalent superficial lesions. The start of empirical medical treatment should not be delayed by the requirement for histologic or laparoscopic confirmation.

Depending on whether the pregnancy is sought and how severe the symptoms are, several treatment options may be used. There is currently no known cure for the disease.

Numerous drugs are available to help treat endometriosis and associated symptoms.

• Analgesics, or painkillers, such as ibuprofen and naproxen, as well as non-steroidal anti-inflammatory medications (NSAIDs) are frequently used to relieve pain.
• Pain management strategies can also involve the use of hormonal medications such as GnRH analogs and birth control methods.
• These methods include oral medications, hormonal IUDs, vaginal rings, implants, injections, and patches

Those who wish to become pregnant might not be able to use these techniques.

In a few cases, endometriosis-related infertility can be treated with fertility drugs and treatments.

Surgery is occasionally done to remove scar tissue, adhesions, and lesions related to endometriosis.

If you are struggling to conceive and suspect endometriosis, don’t hesitate to consult our doctors. Early diagnosis and treatment can make a huge difference in your journey to parenthood.