Endometriosis and infertility

Endometriosis is an incompletely known condition, but increasingly common in young women.

What is the endometrium?

The endometrium is the lining that lines the uterus inside. The endometrium increases after menstruation, under the influence of estrogen hormones, until ovulation.

After ovulation, it transforms under the influence of progesterone, to promote the implantation of the embryo.

If the implantation does not occur, the hormone level decreases and menstruation begins, at which point the upper layer of the endometrium is removed with the menstrual blood.

How does it work and how do it produce effects and symptoms?

Outbreaks of endometriosis react hormonally, develop and then bleed during menstruation, similar to the endometrium.

Bleeding foci implanted in the abdomen (fallopian tubes, ovaries, intestines, abdominal cavity) causes menstrual pain, as well as the formation of clots and subsequent adhesions between the pelvic organs.

These adhesions alter the genital anatomy and function of the fallopian tubes and ovaries, reducing fertility over time and maintaining a state of chronic inflammation.

How is endometriosis detected?

Very often endometriosis is detected during investigations for fertility problems.

Sometimes it is detected by chance, during an ultrasound or surgery

If there is very severe menstrual pain, endometriosis is suspected and a diagnostic laparoscopy (a surgery that treats the disease) is recommended.

What are the risks of the operation?

For women who want children, surgery should not only aim to relieve pain, but also to protect or even improve fertility.

In advanced stages, if you try to loosen all the adhesions or remove the ovarian cyst, the effect may be reversed, and the operation may reduce the chances of successful in vitro fertilization (IVF), by affecting the adjacent healthy ovarian tissue. It is possible that after the operation, the ovary will no longer react to ovarian stimulation.

Other risks: damage to the abdominal organs – complications in the intestine or urinary tract

The operation improves fertility in the early stages of endometriosis.

In advanced stages, IVF is directly recommended, without the need for surgery beforehand.

What to do concretely if you have endometriosis and you want children?
  • Ask your infertility specialist before resorting to surgical treatments
  • Evaluate your ovarian reserve in time – AMH or AFC test
  • If you have been diagnosed with endometriosis in stages I-II, complete with other fertility tests (spermogram, AMH, tubal permeability); if there are no other problems and you are under 35 years old, try to get pregnant naturally 6-12 months then turn to IVF
  • If you have been diagnosed with endometriosis in stages III-IV, consider IVF directly
What is endometriosis?

Endometriosis is a disease in which, for insufficiently known reasons, cells from the endometrium implant and function outside the uterine cavity, in areas other than normal. It is assumed that menstrual blood flows back to the abdomen, causing cells in the endometrium and that, in addition, there are immunological dysfunctions that allow ectopic implantation.

The location of these foci is extremely varied, most commonly in the fallopian tubes, ovaries, abdominal cavity, intestines or bladder.

What are the symptoms of endometriosis?
  • Increased menstrual pain, often overlooked
  • Infertility, often considered an unidentified cause
  • In advanced stages, it can affect the digestive tract or urinary tract with specific symptoms
How is it treated?
  • Medication to treat symptoms (pain) – painkillers or medication that blocks the menstrual cycle
  • Surgery to remove or cauterize foci and loosen adhesions (to relieve pain and increase fertility)
  • Assisted reproduction – In vitro fertilization – if:
    • Endometriosis is in advanced stages (affects the ovaries, adhesions are extensive)
    • Pregnancy does not occur naturally or after 6-12 months after surgical treatment
    • There are other factors that reduce fertility – female age, reduced ovarian reserve, male factors
Can ovarian stimulation be performed for IVF without operating the endometriotic cyst beforehand?

Yes, ovarian surgery does not increase the chances of IVF success, but may even decrease them.

However, if the size of the cyst is very large, intervention may be required before IVF, but not for its removal, but only for decompression (its evacuation).

In this way, ovarian stimulation and oocyte sampling can be helped, without affecting healthy ovarian tissue and without reducing ovarian reserve.

What effect does pregnancy have on endometriosis?

Pregnancy is one of the most effective treatments, helping to relieve symptoms and regress foci of endometriosis. Lack of menstruation for many months is extremely beneficial for women with endometriosis.

Are there additional risks for IVF in women with endometriosis?

Endometriosis affects all stages of IVF, from ovarian stimulation to implantation; may cause resistance to treatment and the need to administer higher doses of medication.

There is also an increased risk of infection after ovarian puncture, especially if endometriosis outbreaks are intercepted. Antibiotics are administered prophylactically in this case.