Is endometriosis a contributing factor that is making it difficult for a couple to conceive?

Shahryar K. Kavoussi, M.D., M.P.H.

Board-Certified Reproductive Endocrinology & Infertility Specialist

Austin Fertility & Reproductive Medicine

 

Endometriosis occurs when the tissue that the lining of the uterus is composed of, also known as “endometrium”, is found within a woman’s body in locations outside of the uterus.  This disease affects approximately 10% of women of reproductive age and the percentage rises to 30% of women with infertility.  

How would a woman know if she had endometriosis?  Pelvic pain symptoms (painful periods and painful deep intercourse, for example,) which affect a woman’s quality of life, may increase suspicion for the presence of endometriosis but laparoscopic day surgery with tissue biopsy is the gold standard for the diagnosis of any stage of endometriosis.

Endometriosis can adversely affect fertility at many levels.   Not only can endometriosis distort the pelvic anatomy and make egg pick-up by the fallopian tube more difficult, but this disease can also adversely affect egg quality, egg numbers, fertilization rates, embryo development, and implantation rates.  While women in the general population have been reported to have a 15-20% chance of pregnancy per month, those with endometriosis may have a 2-10% chance of pregnancy per month.   The time to pregnancy is increased in women with endometriosis who are trying to conceive with natural cycles. 

Fertility treatment options are available for couples with endometriosis-associated infertility.  These can range from ovulation induction medications (Ex: clomid citrate, letrozole, gonadotropins) in conjunction with timed intercourse or intrauterine insemination (IUI), laparoscopic treatment of endometriosis, and in vitro fertilization (IVF).   Success rates vary depending on the degree of endometriosis and the various other fertility factors.  It is important for women with endometriosis to discuss their fertility potential with a fertility specialist in order to optimize the chances for a successful pregnancy.