The Effect of Endometriosis on Women’s Fertility

Endometriosis is characterized by the presence of tissue that resembles the uterine lining but resides outside the uterus. These tissue accumulations are referred to as endometriosis foci, and they can affect all reproductive organs.

However, scientists believe that endometriosis impacts fertility not solely due to the physical presence of tissue around the ovaries around the uterus. It also involves hormonal fluctuations, adhesions, scarring, inflammatory responses, and an overactive immune system, which can disrupt crucial processes necessary for a successful pregnancy. These processes include:

• Ovulation
• The transportation of the egg into the fallopian tube
• The transfer of sperm cells to the mature egg cell
• The implantation of the embryo in the uterus

How common is endometriosis in women with infertility?

Endometriosis stands as one of the most prevalent gynecological conditions affecting women. Classic symptoms encompass severe menstrual pain and abdominal discomfort before or independently of menstruation. However, it is essential to note that endometriosis can manifest without noticeable symptoms.

Among women with infertility, up to 50% may have endometriosis. In contrast, for women with untreated mild endometriosis, the monthly conception rate ranges from 2% to 4.5%, whereas healthy couples typically achieve rates of 15% to 20%, depending on age. For patients with moderate and severe endometriosis, monthly pregnancy rates drop below 2%.

It is crucial to recognize that these statistics represent averages. While some women with endometriosis may face years of trying to conceive, others may quickly achieve pregnancy.

What can you do if you have an unfulfilled desire to have a child and endometriosis?

Achieving pregnancy with endometriosis can be a significant challenge, particularly in cases of severe endometriosis. Surgical removal of endometriosis lesions and tissue can be a viable option to enhance fertility. However, the effectiveness of this approach can vary from person to person, and the decision to undergo surgical treatment should be made based on individual circumstances and needs. One crucial factor to consider is that endometriosis foci have the potential to regrow relatively quickly, emphasizing the importance of timing.

Surgical therapy is typically performed laparoscopically, involving minimally invasive procedures with tiny incisions. Surgical ablation, which entails the removal of tissue using heat, is commonly employed to eliminate endometriosis lesions. Depending on additional factors such as age, ovarian reserve, and uterine anatomy, assisted reproductive techniques like artificial insemination are often recommended. In cases of severe endometriosis, a combination approach may be necessary, involving surgical removal of endometriosis foci followed by artificial insemination.

What are the success rates associated with various treatment approaches?

Surgical treatment can alleviate pain in 60% to 80% of women.

Moreover, surgical intervention can enhance fertility and increase pregnancy rates significantly. Multiple studies indicate that up to 60% of pregnancy rates have been achieved post-surgery, and some individuals may opt for additional in vitro fertilization (IVF) treatments. Women with moderate to severe endometriosis exhibit similar IVF success rates as those without endometriosis.
It is worth noting that a woman’s age and ovarian reserve, assessed by anti-Müllerian hormone levels, play a pivotal role in determining the likelihood of pregnancy.

However, conducting a comprehensive fertility evaluation before pursuing endometriosis treatment is essential. Many women with endometriosis may also contend with other factors that can impact fertility.

Fertility Analysis at LEVY Health

LEVY Health provides a personalized fertility analysis tailored to women who desire to have children but face challenges. This analysis is precious for women who have been diagnosed with or suspect they may have endometriosis, as it thoroughly examines the underlying causes of infertility, enabling the selection of the most appropriate treatment. The fertility analysis at LEVY Health encompasses a comprehensive assessment, including a detailed medical history, an evaluation of personal circumstances, and diagnostics customized to each woman’s unique situation. Based on this evaluation, they offer individualized therapy recommendations.

Begin your fertility analysis by clicking here.

• Centini G et al: Impact of Laparoscopic Surgical Management of Deep Endometriosis on Pregnancy Rate. J Minim Invasive Gynecol. 2016;23(1):113-119.
• Ballester M, Oppenheimer A, d’Argent EM, et al. Nomogram to predict pregnancy rate after ICSI-IVF cycle in patients with endometriosis. Hum Reprod. 2012;27(2):451-456.
• Keresztúri A, Kozinszky Z, Daru J, et al. Pregnancy Rate after Controlled Ovarian Hyperstimulation and Intrauterine Insemination for the Treatment of Endometriosis following Surgery. Biomed Res Int. 2015;2015:282301.
• www.reproductivefacts.org (Zugriff im Januar 2022)