Doctor speaks: Endometriosis causes infertility in 50% of women

● Endometriosis causes infertility in 30-50% of women

● Women aged above 35 years are at greater risk of infertility as well as miscarriage

● Laparoscopy surgery helps restore the normal reproductive functions

More than 25 million women are estimated to be suffering from endometriosis in India. It has emerged as a leading cause of infertility among women says Dr. Vimee Bindra - Fertility Enhancing Surgery Specialist: Endometriosis Excision Surgery Specialist & Co-Founder "ENDOCRUSADERS".

Endometriosis is a common condition affecting 1 in 10 women. In this condition, tissue similar to the lining of the uterus is implanted outside the uterine cavity at ectopic locations. This tissue can be found on ovaries, tubes, peritoneum, bowel, ureter, and at various other extra-pelvic locations such as diaphragm, lungs, etc. This tissue can form its own hormones and it grows and invades the surrounding tissue which causes adhesions, pain, and infertility.

How do I know if I have endometriosis?

Endometriosis may present as painful periods, pelvic, abdominal pain, irregular bleeding, painful sex, and infertility or it may be asymptomatic in some cases. As it involves the pelvic organs and pelvic peritoneum, it causes infertility in 30-50% of women. For some women, there may be a formation of an ovarian cyst called a chocolate cyst which can be picked up on ultrasound.

Common symptoms of endometriosis are

● Very painful menstrual cramps

● Chronic pelvic pain, backache

● Painful sex

● Painful defecation/urination

● Bleeding or spotting

● Infertility

● Stomach /digestive problems simulating idiopathic Bowel Syndrome (IBS)

● Diarrhea and constipation

● Fatigue

● Depression

How does endometriosis cause infertility?

Endometriosis impacts fertility by various mechanisms such as

● It distorts the pelvic anatomy

● Adhesions

● Scarring

● Tubal damage

● Inflammation of pelvic organs

● Affects the egg quality

● Interferes with implantation

● Changes the hormonal milieu

How can be endometriosis treated?

For patients who are looking for pregnancy, treatment will depend on the extent and symptoms of endometriosis. If laparoscopy is done, excision surgery should be done for clearance of endometriosis. The aim of this surgery is to restore the pelvic anatomy and help you restore normal reproductive functions. After surgery, the chances of getting pregnant are improved. Some women with endometriosis conceive spontaneously, some may need ovulation induction or assisted reproductive technology to help them conceive.

The treatment for endometriosis needs to be tailored to one's needs as ONE SIZE DOES NOT FIT ALL

Is there medical treatment for infertility due to endometriosis?

Medical therapy currently available does not remove the disease, your symptoms may subside, but the disease keeps progressing. Evidence does not support fertility enhancement with medical treatment such as COCs, Progestins, GnRH analogs. Surgery combined with medical therapy has shown fertility enhancement in various studies.

Can I conceive without any treatment after surgery?

Younger women with mild to minimal endometriosis may be a candidate for "watchful waiting" after surgery for endometriosis. Approximately 40 % of women may conceive in the first 6 months after laparoscopic excision of minimal or mild endometriosis.

Women above 35 years have lower fertility. So, a decrease in fertility due to endometriosis and age becomes additive. This group of women may need aggressive fertility treatments.

Women with moderate to severe endometriosis may also need aggressive fertility treatments.

Different treatment modalities for endometriosis-related infertility?

Your doctor may offer one of these treatment modalities depending on your requirements, age, and extent of disease.

● Freezing your eggs: some doctors may recommend freezing your eggs in case you wish to become pregnant later as endometriosis decreases ovarian reserve.

● Superovulation and IUI – may be an option for women with mild endometriosis, with patent tubes, and partner having good quality sperm.

● Fertility medications such as Letrozole and Clomiphene may be prescribed

● Regular ultrasounds to ensure egg maturity and timing of IUI

● Advanced options such as IVF, ICSI for moderate to severe endometriosis, or women who have not responded to other treatments.

How can I improve my chances of getting pregnant with endometriosis?

It is important to live a healthy lifestyle that includes an anti-inflammatory diet and pelvic exercises which helps by reducing inflammation in your body.

● Maintain a healthy weight

● Eating a well-balanced diet

● Moderate exercise

Fertility treatment success is age-dependent. Higher fertility is seen in the younger population and women aged above 35 years are at greater risk of infertility as well as miscarriage.