Consultant Gynaecologist

Endometriosis and Infertility

It’s estimated that 40 to 50 percent of infertile women may have endometriosis. Endometriosis may be related to infertility in several ways:

• Women who experience deep pain during intercourse may choose to have intercourse less often, reducing the likelihood of becoming pregnant.
• Scar tissue from endometriosis can form adhesions around the ovary and restrict the available surface area of the ovary for egg release.
• Adhesions affecting the fallopian tubes may interfere with their ability to pick up an egg released by an ovary and transport it to the uterus.
• Occasionally, endometriosis will form inside the fallopian tube, resulting in blockage and making fertilization impossible.
• Endometriosis can disrupt the ovaries’ normal cycle of egg development and release.
• The peritoneal fluid in women with endometriosis contains an increased number of scavenger cells, which have the ability to destroy sperm cells, making fertilization unlikely.

Becoming Pregnant After Treatment

Pregnancy rates following various treatments for endometriosis vary between about 35 percent and 65 percent. Research has shown that for women with minimal or mild endometriosis, there is no proven benefit from medical or surgical treatment versus no treatment at all. Also, the more endometriosis a patient has, the less likely she is to become pregnancy following treatment.

Pregnancy rates are highest in the first one to two years following treatment. If danazol is used together with surgical treatment, pregnancy rates tend to be better when the medication is given before the surgery.

Women who only have minimal or mild endometriosis and who are pain-free will not overall have their fertility prospects improved by having their endometriosis treated. However, if no other cause of infertility is identified, it is reasonable to offer treatment to prevent the endometriosis from progressing. Laparoscopic surgery may be the best treatment in this case.

Infertile patients with moderate or severe endometriosis should be treated even if they have little pain. A six-month course of danazol or GnRH agonists followed by conservative surgery is probably the most effective treatment. Alternatively, conservative (laparoscopic) surgery alone may be used.

Infertility Treatments

Infertility treatments can increase the chances of pregnancy in women with endometriosis . The first step often involves the use of medication to boost the ovaries’ production of eggs. This is combined with inserting male sperm directly into the uterus.

If a woman does not become pregnant within one to two years, she may wish to explore assisted conception. This can be of two types:

• In-Vitro Fertilization (IVF) is a method for treating infertility in which an egg is surgically removed from the ovary and fertilized with the man’s sperm outside the body. If all goes well, the eggs fertilize and the resulting embryos are transferred to the women’s uterus two days later. This is often done if a woman has blocked fallopian tubes.
• Gamete Intrafallopian Transfer (GIFT) involves putting eggs and sperm into the fallopian tubes to be fertilized there. This method is suitable for woman with healthy fallopian tubes.

The decision to try assisted conception techniques may be particularly appropriate for women over age 35. Good pregnancy rates have been reported for both of these techniques, although the success rate was lower in women with severe endometriosis.

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