How to Deal with Fertility Problems Related to Endometriosis

Endometriosis is a condition where parts of the womb end up in different places of the body instead of being shed during the menstrual bleed, as it happens during a healthy cycle. Not only is it a painful condition, it can also cause infertility in 2 out of 5 affected women. During a normal menstrual cycle, the cells that line the inside of the womb are shed. When affected by this disorder, some fail to leave the body and instead end up going to other organs in the body where they attach themselves.

Often they go in the ovaries and fallopian tubes or attached to the outer surface of the womb or intestines. It can also lead to them attaching to the vagina, vulva, bladder, bowel, and cervix or bury into abdominal surgical scars. They continue to respond to hormones produced in the monthly cycle and bleed each month, which leads to internal bleeding and inflammation.

Irregular menstruation cycle, pelvic pain and a predisposition to ectopic and ruptured cysts in the ovaries are further symptoms of endometriosis. Many women with endometriosis experience no symptoms so treatment is not necessary. If symptoms do occur, medication and surgery are the two most common treatment options.

What causes it? It is still unknown what the cause of endometriosis is. One belief is that it may have something to do with 'retrograde' or reverse menstruation. Based on this theory, the tissue flows out the vagina but also travels up and out of the womb via the fallopian tubes, until it sticks to other structures like the abdomen and further. The implanted tissue acts as it would act in the womb and has a monthly bleed. In some cases, the blood is reabsorbed, but in more severe cases it leads to cysts forming which can irritate the pelvis.

What Are The Symptoms? The most common symptom is usually a pelvic pain. Others include painful periods, painful intercourse, pelvic cramps, diarrhea, nausea, allergies, frequent yeast infections and even infertility.

Four Sages of Endometriosis
Stage one (minimal endometriosis) – a few isolated endometrial implants outside of the uterus and mild adhesions.
Stage Two (mild endometriosis) – more and deeper implants less than 5 cm in total and a minimal number of mild adhesions.
Stage three (moderate endometriosis) – many deep implants, small endometrioma or cysts on one or both ovaries, and some filmy adhesions or scars.
Stage four (severe endometriosis) – various deep implants, cysts or large endometrioma on one or both ovaries, multiple adhesions, dense and often found also in other organs.

Stage three and four may require you to work with your doctor to create the best plan for addressing your symptoms which may include surgical procedures such as laparoscopy or excision surgery.

Impact on Fertility Endometriosis should be seen as a chronic disease characterized by pelvic pain and associated with infertility. It is necessary to have a life-long plan on how to minimize the symptoms from recurring. Each woman has individual symptoms and is of different age or fertility, which is why each treatment is also individual. For many women, adequate treatment requires a combination of treatments given over their lifetime. Most common treatments include medical, surgical, or a combination of both.

The ablation of the endometrium was effective for reducing unacceptable pain. This is an alternative to the removal of the uterus. After endometrial ablation, patients did not exhibit retrograde bleeding or endometrial implants. In contrast, patients that did not undergo the ablation procedure exhibited a high recurrence rate of endometriosis.

Endometriosis affects fertility due to the inflammation and irritation it causes. When the fimbria is inflamed, which picks up the egg and transports it into the fallopian tube, it can cause swelling and scarring so the egg may not reach its destination. The sperm and eggs are also affected by the inflammation when they are exposed to the inhospitable environment caused by the endometriosis. In more severe cases, the endometriosis starts to cause adhesions the pelvic organs become stuck to each other, resulting in decreased function. Endometriosis also leads to a blockage of the fallopian tubes.

Pregnancy and Endometriosis
Fortunately, pregnancy actually improves endometriosis. The hormones produced cause most of the endometriosis to resolve. If endometriosis is so severe that it stops conception from happening, then a laparoscopy is necessary. Laparoscopic surgery is a keyhole surgery using a thin telescope with a light inserted through a small cut in the belly button to look into the pelvis. Removing endometrial patches, cysts, nodules, and adhesions, reduces the symptoms and improves fertility.

When this treatment shows to be unsuccessful, in vitro fertilization (IVF) treatments may also be considered. It is in this case very important that your endometriosis is properly treated before starting with in vitro fertilization treatment. IVF treatment includes increasing estrogen levels, which will encourage the development of existing endometriosis.

After surgery, the best chances of conceiving are during the first few months following the procedure. Even after conceiving and most of the endometriosis resolving, your doctors can take steps to prevent the endometriosis from reoccurring. Breastfeeding and birth control pills slow the growth of endometriosis. Once done breastfeeding, it is recommended to start using birth control pills until wanting to conceive again. It’s a plan that shows to get best chances for conceiving without having to endure laparoscopy again and any other infertility treatment.

When diagnosed with endometriosis, medical care should not stop once you become pregnant. Many studies have shown that endometriosis is a risk factor for:
- the baby being born early – before 40 weeks
- bleeding after the 24th week of pregnancy
- high blood pressure (preeclampsia)
- delivery by Cesarean section
A large study of more than 13,000 births showed that women who were diagnosed with endometriosis had a higher risk of complications at birth, preterm birth and of having a Cesarean section. This information helps doctors to identify and monitor pregnant women who have been diagnosed with endometriosis and are therefore at increased risk of premature labor and birth.