Endometriosis and Infertility

What is Endometriosis?

Endometriosis is a common condition that affects women (up to 10%) during the reproductive years. It occurs when tissue similar to the uterine lining (endometrium) attaches to organs in the pelvis and begins to grow. This displaced endometrial tissue causes irritation in the pelvis that may lead to pain and infertility.

Can It Effect My Period?

The endometriosis tissue found in and around the pelvis behaves differently than the normal endometrium found in the uterus. This tissue can shed and bleed during a woman’s period, which can cause irritation of her pelvic organs. It can cause adhesions (scar tissue) that can form on the reproductive organs.

Many women who have endometriosis experience painful periods and/or pain during sex.  Conversely, some women exhibit NO symptoms. Uncommonly, endometriosis can attach to and damage surrounding organs like the bowel, bladder, and ureter (the tube that goes from the kidney to the bladder), which can cause pain with bowel movements and/or urination.  If an office ultrasound demonstrates no potential cause of pelvic pain, your doctor can determine if endometriosis is present by performing a minimally invasive surgical procedure called laparoscopy.  The physician will look inside the pelvic cavity (belly) with a laparoscope (telescope attached to a camera), which is inserted through small incisions.

Can it cause infertility?

If you have endometriosis, it may be more difficult for you to become pregnant. Surgery to remove it may be an option. At the time of surgery, your doctor may evaluate the amount, location, and depth and give you a “score” based on the stage of the endometriosis. This score determines whether your endometriosis is considered minimal, mild, moderate, or severe. The presence of scar tissue will worsen this score.

ASRM Scoring:

• Stage I (Minimal): 1-5 points
• Stage II (Mild): 6-15 points
• Stage III (Moderate): 16-40 points
• Stage IV (Severe): >40 points 

Women with moderate or severe endometriosis can have pelvic adhesions (scar tissue) or endometriomas.  Doctors are certain that adhesions that block the fallopian tubes will prevent an egg from traveling normally from the ovary to the uterus.  This makes it difficult for the egg and sperm to meet.  Minimal or mild endometriosis may only cause minimal amounts of adhesions, but becoming pregnant may still be difficult.

It is only through laparoscopy that your doctor can definitively diagnose endometriosis.  If it is seen at the time of surgery, your doctor will surgically burn or laser or cut and remove the scar tissue. This treatment will allow your reproductive organs to function more normally. Your chances of becoming pregnant are improved after surgical treatment, especially if your endometriosis is in the moderate or severe range.

Endometriosis needs the female hormone estrogen to develop and grow. Birth control pills and other drugs that lower or block estrogen can help symptoms, such as pelvic pain, painful periods, and pain during sex.  For patients who want to become pregnant, medical therapy with birth control pills or medications that cause a short-term, menopausal state may be considered prior to attempts at conception.  Medical therapy may help decrease the pain from endometriosis

We’re here to help

When you come to RRC for your initial consultation, your provider will recommend an infertility evaluation (even prior to one year of infertility) for patients over the age of 35, and for those with irregular menstrual periods, tubal ligation or vasectomy, endometriosis or recurrent pregnancy loss. Give us a call!  We’re here to help you on your path to parenthood.