Endometriosis and fertility: what impact on conception?

Endometriosis is a gynecological disease that affects 1 in 10 women. It takes an average of 7 years to make a diagnosis. Endometriosis is often diagnosed when a couple has difficulty conceiving a baby. A fertility test then shows that the woman has endometriosis. 30 to 40% of women with the disease suffer from infertility.

What is the impact of endometriosis on fertility?

When a patient suffers from endometriosis, the mechanisms that trigger infertility are numerous and will depend on the degree of involvement of the disease and its stage (mild, moderate or severe endometriosis) and the location of the lesions, the age of the patient and her health. How can endometriosis and pregnancy be reconciled? How is endometriosis responsible forhypofertility?

  • Ovulation disorders (dysovulation)
  • Irregular periods, which complicate the calculation of the fertile period
  • Decrease in the follicular reserve, especially when there has been an operation
  • Adhesions that block the fallopian tubes and prevent the egg from meeting a spermatozoon
  • The presence ofendometriomas, cysts on the ovaries which are adnexal lesions
  • An inflammatory state of the entire reproductive system
  • Pain during penetration (dyspareunia) that prevents regular sexual intercourse
  • An increase in lymphocytes and IGA and IgG antibodies that can prevent implantation of an embryo

What are the chances of having a child with endometriosis?

The medical profession considers that a couple is not fertile when no spontaneous pregnancy has occurred after 12 months of regular sexual intercourse and without contraception.
Not all studies are in line to determine the extent to which endometriosis is responsible for infertility. In the case of proven endometriosis, the fertility rate is 2 to 10% per cycle compared to 25 to 30% for fertile couples. Many studies reveal that 35 to 55% of women who are at risk of infertility have endometriosis.
It also depends on the level of disease, the age of the patient and the fertility of the man.

How can fertility be maximized in the case of endometriosis?

It should be remembered that even if you suffer from this endometrial cell disorder, in most cases and except for specific indications, cervical cancer or proven infertility, you can become pregnant naturally, thanks to medical research that is progressing.
When pregnancy does not come naturally, it is important to consult a specialist and to carry out an infertility assessment of the couple. Depending on the results, the gynecologist will suggest different techniques of medically assisted reproduction (MAP) or surgery. In the case of known endometriosis, infertility management is part of the overall management of the disease and involves a holistic, multidisciplinary team: gynecologist, radiologist, gynecological surgeon, urologist, psychologist, naturopath, acupuncturist, osteopath...

Ovarian stimulation

In the first instance and for mild forms, ovarian stimulation or ovulation stimulation is proposed. Several factors such as age and health status of women are taken into account when initiating ovarian stimulation. On average, pregnancies occur between the 3rd and 4th month of treatment.
Ovarian stimulation consists of taking hormones that will influence the production of follicles and their size before ovulation. Throughout the ovarian stimulation, the doctor will monitor ovulation by taking blood samples and pelvic ultrasounds.
There are two ways to take hormones that will boost your fertility:

  • Taking hormones orally with the ingestion of clomiphene citrate tablets
  • By self-administered hormonal injection

Artificial insemination

Artificial insemination is the least expensive and simplest technique. It consists ofinjecting sperm from the spouse or a donor directly into theuterus in a manner synchronized withovulation. This technique represents 37% of the attempts of PMA.
Beforehand, the woman will undergo hormonal treatment or otherwise known as ovarian stimulation so that one to three follicles mature and can then be fertilized. This development is monitored by ultrasound and blood tests.
Once the follicles are ready to ovulate, the day and time of insemination will be scheduled. Sperm are prepared and deposited inside the uterus.
Fertilization takes place inside the woman's body, unlike in vitro fertilization.

In Vitro Fertilization (IVF)

IVF is the most complete technique but also the most invasive, with a risk of complications for the patients and the couple. IVF consists of fertilizing the woman's egg with a sperm in a laboratory. To do this, the man must donate sperm and the woman must perform a collection under anesthesia following ovarian stimulation. The embryos will then be transferred to the uterus. The entire IVF process is closely monitored by doctors.
There are two forms of IVF:

  • Conventional IVF requires the absence of alterations in the spouse's spermogram. The oocytes obtained during the puncture are placed in culture surrounded by the spouse's spermatozoa. The boxes are incubated under natural conditions so that the spermatozoa fertilize the oocyte alone.
  • IVF ICSI (Intra Cytoplasmic Sperm Injection) is proposed when there is male infertility. This technique is based on the selection of the most mobile and best quality spermatozoa under the microscope and injecting them directly into the mature oocyte.

Fertility FAQ with endometriosis

Does endometriosis prevent me from getting pregnant?

Endometriosis is a gynecological disease that is still not well understood and one of the symptoms is infertility. It is now known that 30 to 40% of patients with endometriosis suffer from infertility and 35 to 55% of women who suffer from infertility have endometriosis.

How do you know if you are fertile with endometriosis?