Key Points on Fertility and Endometriosis:
- Endometriosis is a common condition where tissue similar to the lining of the uterus grows outside the uterine cavity.
- It affects approximately 5-15% of women of reproductive age.
- Endometriosis is a leading cause of infertility in women.
- The condition can lead to severe pain, adhesions, and cysts.
- Fertility treatments can increase the chances of pregnancy in women with endometriosis.
Endometriosis: A Common Cause of Infertility
Endometriosis is one of the most common causes of infertility. The condition, where tissue similar to the endometrium grows outside the uterine cavity, affects approximately 5-15% of women of reproductive age (Moradi, 2021).
Endometriosis not only makes it difficult to conceive but can also cause severe pain and other health problems.
What is Endometriosis?
Endometriosis is a chronic condition where tissue resembling the uterine lining (endometrium) grows outside the uterus. This tissue can settle in the pelvic area, on the ovaries, fallopian tubes, or even on distant organs such as the bowel or bladder.
A specific form of endometriosis is adenomyosis, where the endometrium infiltrates the muscle layer of the uterine wall. This can lead to an enlarged uterus, severe pain, and impaired fertility.
Stages of Endometriosis
The American Society for Reproductive Medicine (ASRM) categorizes endometriosis into four stages:
- Stage I (minimal): Small endometriosis lesions without significant adhesions.
- Stage II (mild): Multiple superficial lesions and minor adhesions.
- Stage III (moderate): Deeply infiltrating lesions, endometriotic cysts on the ovaries ("chocolate cysts"), and noticeable adhesions.
- Stage IV (severe): Severe endometriosis with large cysts, severe adhesions, and involvement of multiple organs.
How Does Endometriosis Affect Fertility?
Endometriosis can affect fertility in various ways:
- Adhesions: Endometriosis can lead to adhesions or scar tissue in the abdominal cavity, which can act as mechanical barriers and disrupt the normal interaction of reproductive organs. Adhesions may block or deform the fallopian tubes, preventing the egg from being transported. Endometriosis lesions on or around the uterus can affect its shape or mobility and hinder the path for sperm.
- Endometriotic cysts (endometriomas): Endometriomas can displace healthy ovarian tissue, reducing the number of available eggs. Inflammatory processes in the abdominal cavity and oxidative processes from the cysts can reduce egg quality.
- Inflammation: Inflammation damages the microenvironment where eggs mature. Inflammatory substances can reduce sperm motility and viability. The uterine lining becomes less receptive to implantation due to inflammation.
- Hormonal Imbalances: Hormonal imbalances can lead to irregular or absent ovulation. A lack of progesterone can impair the preparation of the uterine lining for implantation. Studies show that women with endometriosis have a higher likelihood of infertility compared to those without the condition. Estimates suggest that 30 to 50% of affected women have difficulty conceiving naturally (Bulletti, 2010).
Diagnosis and Treatment of Endometriosis
Diagnosis
The diagnosis of endometriosis is usually made through a combination of the following examinations:
- Medical History: A detailed discussion with your gynecologist about your medical history and symptoms (e.g., pelvic pain, abnormalities in your menstrual cycle) is the first step in investigating endometriosis.
- Gynecological Examination: Palpation can detect hardenings or nodules in the pelvic and abdominal areas that may indicate endometriosis. Imaging Techniques: An ultrasound examination can help identify endometriotic cysts on the ovaries. MRI provides more detailed images and can visualize deep endometriosis.
- Laparoscopy: Laparoscopy is both a surgical treatment and diagnostic tool for endometriosis. Through small incisions in the abdominal cavity, the doctor can use a camera to view the organs and directly identify and remove endometriosis lesions.
- EndoTest: Since 2021, there has been a novel test on the market that can detect endometriosis in saliva. This test costs around 800 EUR and is currently not reimbursed by health insurance.
Treatment of Endometriosis
The treatment of endometriosis depends on individual symptoms, existing fertility desires, and the severity of the condition. There are various approaches:
- Laparoscopy with removal of endometriosis lesions: The goal of surgical interventions is to surgically remove endometriosis lesions and cysts to alleviate pain and improve fertility. In severe cases, a more extensive operation may be necessary.
- Hormone Therapy: Hormonal treatment with medications such as GnRH agonists or progesterone can inhibit the growth of endometriosis lesions but is often incompatible with fertility desires.
- Pain Relief: Pharmacological therapies with pain relievers and anti-inflammatory drugs can alleviate acute pain. Complementary therapies such as acupuncture, osteopathy, physiotherapy, or relaxation techniques can also help reduce pain.
Fertility Treatments for Endometriosis
The good news is that many women can conceive despite having endometriosis. Spontaneous pregnancy is also possible with endometriosis. However, if natural conception is unsuccessful, there are various treatment options available to help manage symptoms and improve fertility.
If natural pregnancy is not achieved, assisted reproductive techniques may be considered. The following methods are suitable:
In vitro fertilization (IVF): Eggs are fertilized outside the body, and the embryo is then transferred into the uterus. IVF is particularly effective for endometriosis as it bypasses adhesions.
Intracytoplasmic sperm injection (ICSI): A single sperm cell is injected directly into the egg. ICSI is an option when sperm quality is limited.
Intrauterine insemination (IUI): Processed sperm is inserted directly into the uterus. IUI is often less successful in endometriosis compared to IVF or ICSI due to inflammation and adhesions hindering sperm migration to the egg.
Success Rates
Success rates depend on the stage of endometriosis, the woman's age, egg reserve, sperm quality, the experience of the fertility center, and other factors.
Studies show that IVF is often successful in women with endometriosis, especially when endometriosis lesions have been removed beforehand (Zhong, 2021).
The chances of pregnancy are highest when the woman is younger than 35 years old and has only mild endometriosis (Morcel, 2024).
How Can I Get Pregnant with Endometriosis?
The good news: Getting pregnant with endometriosis is possible!
In addition to medical treatment, scientific studies have shown that certain nutrients can improve egg quality even in women with endometriosis. Essential nutrients include Coenzyme Q10 in the form of ubiquinol, vitamin D, omega-3 fatty acids, and numerous antioxidants such as alpha-lipoic acid (Hart, 2024).
A healthy and active lifestyle is also important, as well as avoiding stress, smoking, and excessive alcohol consumption.
Endometriosis may complicate the path to parenthood, but it cannot completely block it. Thanks to advances in reproductive medicine, there is hope and ways to realize the dream of becoming a parent, even with this challenging condition.
Conclusion
Endometriosis is a complex condition that affects the fertility of many women. However, advances in diagnosis and treatment, especially in reproductive medicine, offer hope and realistic chances of pregnancy. Early diagnosis and individualized treatment, combined with a healthy lifestyle, balanced anti-inflammatory diet, and adequate supply of high-quality micronutrients that support egg quality, pave the way to parenthood.
FAQ
What are typical symptoms of endometriosis?
Typical symptoms of endometriosis can vary widely from mild to severe. The severity of symptoms does not always correlate with the severity of endometriosis. Some women have few or no symptoms despite having extensive endometriosis, while others with milder forms may be severely affected. Common symptoms include cyclic pain, occurring around the time of menstruation.
The most common signs include:
- Severe menstrual pain (dysmenorrhea)
- Chronic pelvic pain
- Pain during intercourse (dyspareunia)
- Painful urination
- Painful bowel movements
- Heavy or prolonged bleeding (menorrhagia)
- Spotting between periods
- Bloating and abdominal pain (endo-belly)
- Nausea or digestive problems
- Fatigue and tiredness
Can endometriosis recur after laparoscopy?
Yes, endometriosis can recur after laparoscopy.Studies show that in about 20-50% of women, endometriosis reoccurs within 5 years after surgery (Guo, 2009).Without hormonal follow-up treatment, remaining or newly developed lesions can be reactivated by menstrual cycles.Women with severe endometriosis (Stage III or IV) have a higher risk of recurrence.What causes endometriosis?
The causes of endometriosis and its exact mechanisms are not fully understood. Various factors likely play a role, such as retrograde menstruation, genetic predisposition, a changed immune system, and hormonal influences. Environmental factors might also increase the risk of endometriosis. Research is actively working to better understand the causes and develop new treatment options.
How can recurrence be prevented?
Surgical therapy combined with hormonal treatment (e.g., progestins or GnRH analogs) can reduce the risk of recurrence.Continuous use of hormonal contraceptives (e.g., the pill) can inhibit the growth of endometriosis lesions.Women with endometriosis should have regular check-ups with their gynecologist or at a specialized endometriosis center to detect potential recurrences early.
Do women with endometriosis have a higher risk of miscarriage?
Yes, studies suggest that the risk of miscarriage is higher in patients with endometriosis. A meta-analysis involving over 50,000 women found that the miscarriage risk in pregnant women with endometriosis was 35.8%, compared to 22% in women without endometriosis (Kohl Schwartz, 2017).References
Zhong et al. Analysis of IVF/ICSI Outcomes in Endometriosis Patients With Recurrent Implantation Failure: Influence on Cumulative Live Birth Rate. Frontiers in Endocrinology, 2021.
Morcel et al. What is the impact of endometriosis and the AFS stage on cumulative pregnancy rates in IVF programs? Reproductive Health, 2024.
Bulletti et al. Endometriosis and infertility. Journal of Assisted Reproduction and Genetics, 2010.
Hart, Roger J. Nutritional supplements and IVF: an evidence-based approach. Reproductive Biomedicine Online, 2024.
Guo, Sun-Wei. Recurrence of endometriosis and its control. Human Reproduction Update, 2009.
Kohl Schwarz et al. Endometriosis, especially mild disease: a risk factor for miscarriages. Fertility and Sterility, 2017.
