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 is suffering from 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 disease involvement and its stage (mild, moderate or severe endometriosis), the location of lesions, the patient's age and state of health. How can endometriosis and pregnancy be reconciled? How does endometriosis causehypofertility?

  • Ovulation disorders (dysovulation)
  • Irregular periods, which complicate the calculation of the fertile period.
  • Decreased follicular reserve, particularly after surgery
  • Adhesions blocking the fallopian tubes, preventing the egg from meeting a spermatozoon.
  • the presence ofendometriomas or cysts on the ovaries, which are adnexal lesions
  • Inflammation of the entire reproductive system
  • Pain on penetration (dyspareunia), preventing regular intercourse
  • An increase in lymphocytes and IGA and IgG antibodies, which can prevent the 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 intercourse and without contraception.
Studies are not all aligned to determine to what extent endometriosis is responsible for infertility. In proven cases of endometriosis, the fertility rate is 2-10% per cycle, compared with 25-30% for fertile couples. Many studies reveal that 35-55% of women at risk of infertility suffer from endometriosis.
It also depends on the level of disease, the patient's age and the man's fertility.

How to maximize fertility in the case of endometriosis?

It's worth remembering that even if you suffer from this endometrial cell disorder, in most cases and barring special indications, such as cervical cancer or proven infertility, you can get pregnant naturally, thanks to the progress of medical research.
When pregnancy does not come naturally, it's important to consult a specialist and carry out an infertility assessment for the couple. Depending on the results, the gynecologist will suggest various techniques for medically assisted procreation (MAP) or surgery. In the case of known endometriosis, infertility treatment 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

Ovarian stimulation, or ovulation stimulation, is proposed as a first-line treatment for mild forms of infertility. Several factors, such as a woman's age and state of health, are taken into account when initiating ovarian stimulation. On average, pregnancies occur between the 3rd and 4th month of treatment.
Ovarian stimulation involves taking hormones that will influence follicle production and size prior to ovulation. Throughout ovarian stimulation, the doctor will monitor ovulation by taking blood samples of hormone levels and performing pelvic ultrasound scans.
There are two ways of taking hormones to boost fertility:

  • Oral intake of clomiphene citrate tablets
  • By self-administered hormonal injection

Artificial insemination

Artificial insemination is the cheapest and simplest technique. It involvesinjecting sperm from a partner or donor directly into theuterus, synchronized withovulation. This technique accounts for 37% of all MAP attempts.
Beforehand, the woman undergoes hormonal treatment, otherwise known as ovarian stimulation, so that one to three follicles mature and can then be fertilized. This development is monitored by ultrasound scans and blood tests.
Once the follicles are ready to ovulate, the day and time of insemination are scheduled. Sperm are prepared and deposited inside the uterus.
Unlike in vitro fertilization, fertilization takes place inside the woman's body.

In Vitro Fertilization (IVF)

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

  • Conventional IVF requires no alterations to the spouse's spermogram. The oocytes obtained during the puncture are placed in culture surrounded by the spouse's sperm. The dishes are incubated under natural conditions, so that the sperm alone can fertilize the oocyte.
  • IVF ICSI (Intra Cytoplasmic Sperm Injection) is proposed in cases of male infertility. This technique is based on microscopic selection of the most mobile and highest-quality spermatozoa, which are then injected directly into the mature oocyte.

FAQs on fertility with endometriosis

Does endometriosis prevent pregnancy?

Endometriosis is a still little-known gynecological disease, one of whose symptoms is infertility. Today, we know that 30 to 40% of patients with endometriosis suffer from infertility, and 35 to 55% of women with infertility suffer from endometriosis.

How do you know if you're fertile with endometriosis?