WHAT IS ENDOMETRIOSIS?
Endometriosis is a diagnosis common among girls and women in their reproductive years. It is a condition in which endometrial tissue (tissue that lines the inside of the uterus) grows outside the uterus and eventually sheds into the abdominal cavity. Inflammation occurs in the areas where the blood pools, forming scar tissue. When the endometrial tissue forms on other reproductive organs aside from the inside of the uterus, it interferes with ovulation, tubal transport, and embryo quality.
SYMPTOMS OF ENDOMETRIOSIS
One of the most common signs of endometriosis is abnormally painful menstrual cramps. If you tend to feel extremely painful cramps, or pain with intercourse, it might be time to see a specialist to seek further information. However, some women experience no symptoms at all, and are only diagnosed when they struggle with conception.
CAUSES OF ENDOMETRIOSIS
The cause of endometriosis is still unknown. One theory suggests that during menstruation, some of the menstrual tissue backs up through the Fallopian tubes into the abdomen, where it implants and grows. Another theory suggests that endometriosis is a genetic birth abnormality in which endometrial cells develop outside the uterus during fetal development.
HOW DOES ENDOMETRIOSIS AFFECT INFERTILITY?
Since the endometrial tissue behaves the same way that it would when inside the uterus, it swells and bleeds but without the proper exit from the body. The inflammation is thought to prevent proper tubal transport, which is what propels the gametes and embryos. Additionally, the scar tissue that forms as a result of the swelling can block the Fallopian tubes or obstruct ovulation.
As many as one third to one half of women struggle with getting pregnant when diagnosed with endometriosis. Any degree of endometriosis can have a great impact on fertility, therefore it is important that you see a fertility specialist as soon as you are diagnosed to discuss pregnancy options.
A fertility specialist will make a personalized treatment plan by taking into account your age, the stage of your endometriosis, and the duration of your infertility. Whether or not to have surgery or more surgery is controversial and a case-by-case decision. Given more recent studies, the physicians at Shady Grove Fertility are no longer as apt to recommend surgery. We realize now that repeated surgery may be detrimental to a woman’s ovarian reserve, and does not necessarily lead to an improvement in fertility.
GETTING PREGNANT WITH ENDOMETRIOSIS
Every treatment plan at SGF is customized to fit the patient’s unique diagnosis. Getting pregnant with endometriosis is very possible for most women. While endometriosis may make it harder to conceive on your own, your chances of getting pregnant with endometriosis can be high, depending on the severity of your condition, your age, your overall health, and your treatment options.
With both low tech and high-tech treatment, pregnancy is possible. Since endometriosis can take many forms, and the success rates of treatments vary, your doctor will outline your best treatment options with an individual plan for you.
DIAGNOSTIC TESTS FOR ENDOMETRIOSIS
HOW IS ENDOMETRIOSIS DIAGNOSED?
There are a few warning signs that should lead you to consider talking to your doctor about endometriosis. The first, being those pesky cramps. If they last longer than your period does and inhibit day to day activities, then they may not be from your monthly menstrual cycle. Once you discuss the possibility of the diagnosis with your doctor, he/ she may conduct a laparoscopy (an outpatient surgical procedure where a narrow, fiber-optic camera is inserted through an incision near the navel to look for and remove endometrial implants and scar tissue) exam to confirm.
The only way to truly know is for a gynecologist to look inside the pelvis via a laparoscope, take a biopsy, and confirm it under the microscope. But naturally we don’t want to operate just to answer that question. So, we have to rely on other clues. Patients with this condition may have symptoms of pelvic pain, back or rectal pain, and/or very painful periods. Sometimes these women will have pain with intercourse. Mainly, we can get a pretty good idea of whether someone has endometriosis, at least the most severe forms, with a pelvic ultrasound. On ultrasound we often can see those cysts—or what we call endometriomas.
The tricky part is that there is no one-size-fits-all when it comes to this condition. Not all patients with endometriosis will have pain, and in fact some patients with very advanced endometriosis may have no pain whatsoever. And some patients with very minimal endometriosis will have horrible pain, which is why there is continuing research in this area.
TREATMENT FOR ENDOMETRIOSIS
Women who are diagnosed with endometriosis fall into a variety of categories. For all of these situations, we recommend that you see a fertility specialist who can devise an appropriate treatment plan to help you conceive, or determine a plan for future family building if you are not yet ready to have a baby.
I HAVE PAIN AND I AM TRYING TO GET PREGNANT
If you have already been diagnosed with endometriosis, patients with pain from endometriosis who are trying to conceive can sometimes feel like they are in a catch 22. They have to stop the hormonal medication that is providing them with pain relief, but then they feel an additional sense of urgency—not to mention discomfort—if they don’t conceive in a given month.
For patients with pain from endometriosis, they might consider having surgery to alleviate the pain, which can buy a window of time in which they can hopefully conceive. Seeking consultation with a fertility specialist prior to such a decision can be helpful to maximize the chances of pregnancy after surgery. After surgery, we may decide to pursue fertility treatment to expedite pregnancy, with either medications like clomiphene citrate (Clomid or Serophene) with an intrauterine insemination (IUI) or even in vitro fertilization (IVF). The good news is that once a woman is pregnant, her pain from her endometriosis usually subsides during the pregnancy itself.
I HAVE NO PAIN, AND I’M TRYING TO GET PREGNANT
The puzzling part of endometriosis is that the degree of disease does not always correlate with the degree of pain that a patient experiences. Some women only have infertility as a consequence of endometriosis, and do not have any pain at all. For these women, the benefit of surgery is less clear, but fertility treatment can be very helpful. This could be either medication to stimulate the ovaries combined with an IUI or IVF.
With proper counseling and care, the chances of getting pregnant with endometriosis are high for most women.
HAVE PAIN BUT ARE NOT TRYING TO GET PREGNANT
If you are experiencing pain because of your endometriosis and you are NOT trying to conceive, your gynecologist can prescribe a variety of hormonal medications that can help alleviate the pain. If medications are unsuccessful, you may want to consider having surgery if you have not done so before, and we would recommend doing so in the hands of a surgeon who is experienced in endometriosis—and laparoscopy in general. This may be your gynecologist or another experienced surgeon. If you know you want to have a baby at some point, but not right now, then you should also be aware that there are options to preserve your fertility through egg freezing at this point in time.
Recognizing that the number of eggs a woman has will decrease over time, and recognizing that endometriosis does tend to worsen with time, many women are now choosing to proactively freeze their eggs in the event that their endometriosis threatens their fertility in the future. Also, while laparoscopic surgery can help to reduce the pain associated with endometriosis, it can also negatively affect your ovarian reserve. Therefore, freezing your eggs prior to surgery ensures you have options in the future. This is a conversation to have with a fertility specialist who can best guide you in your decision-making process.
Why is endometriosis classified by stages?
Doctors classify endometriosis as minimal (stage 1), mild (stage 2), moderate (stage 3), or extensive (stage 4), based on the amount of scarring and diseased tissue found. Staging is important for determining which treatment will be best for you.
If I already had surgery for endometriosis, should I have more surgery?
While surgery can be helpful in alleviating pain, we have to be careful not to continue to operate every time a cyst develops, because with each excision to the ovary, we are also losing healthy eggs. Also, additional surgery does not increase the chances of pregnancy after IVF.
HOW TO GET STARTED
Shady Grove Fertility has treatment options to help almost everyone build the family of their dreams. And it all starts with one call:1-888-761-1967
ON-DEMAND WEBINAR: GETTING PREGNANT WITH ENDOMETRIOSIS
One in 10 women of reproductive age is affected by endometriosis. Join us for an on-demand event to learn more about endometriosis and the treatments that are now available to help women conceive.
E-BOOK: GETTING PREGNANT WITH ENDOMETRIOSIS
Learn about how endometriosis affects your fertility and read through some of our SGF patient stories of hope.