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Endometriosis

Endometriosis And Infertility

Infertility can be distressing, and many people experience bouts of stress, depression, or low self-esteem1. If you and your partner struggle to have a baby, you’re not alone2. According to the World Health Organization, 15% of reproductive-aged couples worldwide are affected by infertility1.

Infertility is defined as not being able to get pregnant after one year (or longer) of regular unprotected sex. It refers to couples: both women and men can be impacted by infertility2.

One of the most common causes of infertility is endometriosis (a condition when tissue similar to the lining of the uterus starts to grow in other places)3, which affects 10% of women globally4. About 25 to 50% of infertile women have endometriosis5. There is a close relationship between infertility and endometriosis7.

Causes of endometriosis

Endometriosis is a disorder in which tissue similar to the tissue that usually lines the inside of the uterus — the endometrium — grows outside the uterus. Endometriosis most commonly involves ovaries, fallopian tubes and the tissue lining pelvis. Rarely endometrial-like tissue may be found beyond the area where pelvic organs are located, for example, in the abdominal cavity6. 

Unfortunately, the exact cause of endometriosis is not known6. One of the theories suggests a hormonal imbalance. For example, when hormones such as estrogen change embryonic cells — cells in the earliest stages of development — into endometrial-like cells6.

Other causes are rare, but there are multiple risk factors which are associated with the development of endometriosis6,7:

  • Early age of starting your period 
  • Shorter menstrual cycle
  • Heavy menstrual bleeding
  • Diet high in fat and red meat
  • Immune disorders
  • Prior surgeries or medical therapy
  • Never given birth
  • Reproductive system diseases
  • Endometriosis in a first-degree relative (mother, aunt or sister)

None of these reasons can fully explain why endometriosis happens. It is caused by a combination of different factors10.

Endometriosis-associated infertility

Endometriosis is considered one of the three major causes of female infertility. In mild to moderate cases, infertility may be temporary. In these cases, surgery to remove adhesions, cysts and scar tissue can restore fertility3. Also, it is important to remember that getting pregnant with endometriosis is possible, although it may not be easy6.

How endometriosis affects fertility is not clearly understood. Pelvic adhesions and scar tissue can disturb the connection between ovaries and fallopian tubes (the tubes where egg cells travel to the uterus) or block tubes. All these can impair oocyte release from the ovary, inhibit ovum pickup, or impede ovum transport. As a result, it is harder to get pregnant3.

Also, endometriosis is one of the main causes of the development of adhesions which is not connected with the previous operation. Adhesions may form because of endometrial tissue seeping into the surrounding area and can be responsible for infertility8.

When infertility is suspected, it is better to exclude endometriosis. With its detection and timely treatment, the chances of getting pregnant increase significantly9.

See your doctor and discuss any of the symptoms or signs you are faced with.

References

  1. Infertility https://www.who.int/health-topics/infertility#tab=tab_2 (Last access 15.06.2022). 
  2. Infertility. Symptoms and causes https://www.mayoclinic.org/diseases-conditions/infertility/symptoms-causes/syc-20354317 (Last access 15.06.2022).  
  3. Endometriosis https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis(Last access 15.06.2022). 
  4. Endometriosis https://www.who.int/news-room/fact-sheets/detail/endometriosis (Last access 15.06.2022). 
  5. Bulletti C, et al. Endometriosis and infertility. J Assist Reprod Genet. 2010;27(8):441-447.
  6. Endometriosis. Symptoms and causes https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656 (Last access 15.06.2022). 
  7. McLeod BS, Retzloff MG. Epidemiology of endometriosis: an assessment of risk factors. Clin Obstet Gynecol. 2010;53(2):389-96.
  8. Abd El-Kader AI, et al. Impact of Endometriosis-Related Adhesions on Quality of Life among Infertile Women. Int J Fertil Steril. 2019 Apr;13(1):72-76.
  9. Coccia ME, et al. Endometriosis and Infertility: A Long-Life Approach to Preserve Reproductive Integrity. Int J Environ Res Public Health. 2022;19(10):6162.
  10. Endometriosis – NHS https://www.nhs.uk/conditions/endometriosis/ (Last access 15.06.2022).