Written by Rachana V. Garde, M.D., of Shady Grove Fertility’s Woodbridge, VA, and Annandale, VA, offices
Endometriosis is a condition that occurs when tissue that lines the uterus—known as endometrial tissue—grows outside of that organ and attaches itself somewhere else, such as the ovaries or fallopian tubes. This tissue responds to your menstrual cycle hormones by swelling, thickening, and then shedding to mark the beginning of the next cycle. While the bloodshed from the uterus is discharged through the vagina during your period, the bloodshed from endometrial tissue that grows in the pelvis remains and can become scar tissue. This scar tissue can grow to block the fallopian tubes and interfere with ovulation. Additionally, endometrial tissue that spreads to and grows inside the ovaries may form a type of ovarian cyst called an endometrioma, which can potentially affect fertility.
If you have been diagnosed with or believe you may have endometriosis and are wondering whether you can get pregnant, the answer is yes for many women. While endometriosis may make it harder to conceive on your own, your chances of becoming pregnant can be high—depending on the severity of the condition, your age, overall health, and the treatment option you choose.
“Endometriosis is not always easy to diagnose,” explains Rachana V. Garde, M.D. In some women there appears to be a genetic link, this is not the case for others. Some of the most frequently reported symptoms of endometriosis include:
- Severe menstrual cramps
- Chronic abdominal pain
- Pain with intercourse
- Excessive bleeding
While many of the symptoms listed above are common, it is important to know that about a third of women with endometriosis will not experience any symptoms. On the contrary, some women that experience similar symptoms will ultimately be found to not have this condition, says Dr. Garde.
The only way to definitively diagnosis endometriosis is through an outpatient procedure called a laparoscopy. Historically, during this procedure the doctor would insert a thin scope near your navel to look for, and sometimes remove, endometrial tissue that is outside of your uterus. “As the medical literature continues to explore this type of surgery, it’s becoming less recommended for the purpose of diagnosis,” explains Dr. Garde. “Studies have found that surgery, especially on or around the ovaries, can damage the ovarian tissue, which can result in a decrease in ovarian reserve (egg supply). This decrease can ultimately make conception more difficult in the future.”
Dr. Garde suggests that women with the symptoms associated with endometriosis speak with a fertility specialist prior to initiating any exploratory surgery, in order to determine options and the appropriate next steps that will not compromise fertility potential.
Treatment Options for Women with Endometriosis
“For any woman that has or suspects endometriosis, the first step prior to treatment is to complete a full infertility work-up to identify any other potential challenges such as age or male fertility issues that the couple may experience when trying to conceive,” says Dr. Garde. A fertility specialist can help you rule out other health issues and determine which treatment options are best for you, depending on how far your endometriosis has progressed and if other factors may otherwise prevent conception. As you advance in age, your treatment options can become more limited—even if your condition is mild—so seeking help sooner rather than later is suggested.
Many women with endometriosis will start with a basic form of treatment called intrauterine insemination (IUI). During this treatment, the physician will prescribe medication to stimulate and grow one to two follicles containing an egg in the ovary. At the time of ovulation, the physician will perform the insemination, which involves placing a concentrated amount of sperm into the uterus. If these treatments don’t work over time, you have more severe endometriosis, or other factors that would impact the chances of success, your doctor may recommend moving to in vitro fertilization (IVF).
Waiting to Conceive
If you have endometriosis and do not have plans to conceive at this time or in the near future, preserving your fertility through egg freezing is recommended. While laparoscopic surgery can help to reduce the pain associated with endometriosis, it can also negatively affect your ovarian reserve. Therefore, freezing prior to surgery ensures you have options in the future.
If you have endometriosis and are trying to become pregnant—or think you may want to become pregnant in the future—don’t wait to speak with a fertility doctor. With proper counseling and care, endometriosis doesn’t have to stand between you and your dream of having a family.
If you would like to learn more about endometriosis or to schedule an appointment, please speak with one of our New Patient Liaisons at 877-971-7755.