Endometriosis is one of the leading causes of infertility in reproductive-aged women. Endometriosis.Org estimates that approximately 176 million women worldwide are affected.
The disease affects 1 in 10 women during their reproductive years, irrespective of their racial, cultural or social-economic background.
Endometriosis-related infertility Research.
30-40% of women with endometriosis, experience infertility yet there has been little research done on this topic. One can only speculate why. Is it because of a lack of awareness? Or is it because endometriosis is under-diagnosed? Whatever the case may be, countless women remain undiagnosed and thus suffer in silence.
Why is it difficult for women with endometriosis to conceive?
Many researchers have proposed why it is harder for women with endometriosis to get pregnant, but none of these theories is a fact.
Some theories out there are:
· Distorted female pelvic anatomy: It is believed that endometrial scar tissue impedes the passage of the egg down the Fallopian tube.
· Poor quality of the egg. It is assumed that women with endometriosis produce poor egg quality, making it difficult for them to conceive.
· Chemicals produced by the endometrial tissue, prevent the movement of the egg down the Fallopian tube.
· Inflammation caused by the endometrial tissue triggers the immune cell to attack the sperm as it views it as a foreign body.
Treatment of endometriosis-related infertility.
Although it is difficult for women with endometriosis to conceive, many women with documented endometriosis have conceived and given birth to healthy children without medical aid.
Treatment of endometriosis-related infertility cannot be done without a complete evaluation of both couples.
The treatment of endometriosis depends on the following factors.
· Age of women at the time of presentation
· Co-morbid medical complication (Women with multiply diagnosis like polycystic ovarian syndrome, hypertension, diabetes) have a harder time getting pregnant compared to women without complication
· Stage of the “women endometriosis”
There are four staging systems for testing endometriosis
· Stage I endometriosis is also known as the (minimal disease): The woman has few endometrial tissue implants, no adhesion, and normal reproductive female anatomy.
· Stage II endometriosis also known as the (mild disease): Here the woman has more endometrial tissue implants with no adhesion.
· Stage III endometriosis also known as (moderate disease): Endometrial tissue is seen in the abdomen, ovaries and the tube, with scar formation. The female reproductive anatomy is distorted,
· Stage IV endometriosis also known as (severe disease): Many endometrial tissues are implanted in the ovaries, rectum, abdomen and around the ovaries and the Fallopian tubes leading to scarring and distortion of the female reproductive anatomy
Treatment of endometriosis-related infertility
There are three documented methods for managing endometriosis-related infertility.
· Hormonal treatment
· Surgical treatment
· Assisted reproductive technologies (ART)
Research has shown any difference in spontaneous pregnancy between women taking hormonal treatment and those not taking them. Although your doctor may prescribe hormonal treatment like (GnRH agonists, Danazol, Medroxyprogesteroneacetate) they are used to manage signs and symptoms associated with endometriosis. Your doctor may allow time for spontaneous pregnancy to occur before proceeding to other treatment modalities,
The main aim of surgical treatment is to restore the female pelvic anatomy by removing the endometrial tissue implants.
Minimal -Mild endometriosis.
Surgical treatment is more successful in women less than 35 years old with minimal and mild disease.
There is no clinical evidence that suggests that surgical removal of endometrial tissues implants aids in pregnancy, especially for older women (35 or older)
There have been many non-randomized uncontrolled studies done on moderate-to-severe endometriosis with inconstant results. The postoperative pregnancy rate is estimated to be between 30%–67% success rate,
Other forms of fertility treatment are often advised in the severe stage
Assisted reproductive technologies (ART)
There are two types of ART
· Intrauterine insemination (IUI)
· In vitro fertilization (IVF)
Intrauterine insemination (IUI)
This means the transfer of semen right into the uterus. These can be done with or without fertility medications.
Minimal -Mild endometriosis.
Using hormonal drugs like clomiphene citrate with intrauterine insemination has increased the success rate of women getting pregnant. Endo-women should be patient when undergoing IUI treatment as only 10% of women less than 40 years old gets pregnant with one treatment cycle. If this treatment is unsuccessful after 3–4 intrauterine insemination cycles, your physician would likely pursue other forms of treatment.
Depending on the severity of the disease, patient age and if pregnancy does not occur after six to 12 months. In vitro fertilization is commonly advised.
In vitro fertilization (IVF)
IVF is usually the recommendation for severe endometriosis or for Mild-Moderate endometriosis particularly for women that has not conceived on IUI. The statistic of IVF pregnancy in Endo-related infertility remains a point of controversy in the medical community. Some studies have shown as much as a fourfold likely hood of getting pregnant. For women with Endo-related infertility, a chance is a welcome opportunity and the increased likelihood of having a baby.