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 impact does endometriosis have on fertility?
When a patient suffers from endometriosis, the mechanisms that trigger infertility are numerous and depend on the degree of disease 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) l
- Irregularperiods , complicating the calculation of the fertile period
- Decreased follicular reserve, especially after surgery
- Adhesions blocking the fallopian tubes and preventing the egg from meeting a spermatozoon.
- the presence ofendometriomas or cysts on the ovaries, which are adnexal lesions
- An inflammatory state of the entire reproductive system
- Pain during penetration (dyspareunia) that prevents regular intercourse
- An increase in lymphocytes and IGA and IgG antibodies, which can prevent embryo implantation
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 without contraception.
Studies are not all aligned to determine the extent to which 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 endometriosis?
It's worth remembering that even if you suffer from this endometrial cell disorder, in most cases you can become pregnant naturally, thanks to the progress of medical research, unless there are special indications, such as cervical cancer or proven infertility.
When pregnancy doesn't come naturally, it's important to consult a specialist and carry out a couple's infertility assessment. 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 or ovulation stimulation is proposed as a first-line treatment for mild forms of infertility. Several factors, such as the age and state of health of women, 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 using hormones to boost fertility:
- Oral hormone intake with clomiphene citrate tablets
- By self-administered hormonal injection
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 patients and couples. IVF involves fertilizing the 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 anaesthetic 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 for direct injection into the mature oocyte.
FAQs on fertility with endometriosis
Does endometriosis prevent pregnancy?
Endometriosis is a little-known gynecological disease, one of whose symptoms is infertility. It is now known that 30 to 40% of patients with endometriosis suffer from infertility, and 35 to 55% of women with infertility suffer from endometriosis.