Endometriosis: A Common Cause of Infertility

Endometriosis is a common condition affecting up to one in ten women during their reproductive years, and it is also a known cause of infertility. Unfortunately, endometriosis is often undiagnosed or misdiagnosed, severely impacting the quality of life for millions of women.

For this reason, our team at Medfem Fertility Clinic are enthusiastic supporters of #EndometriosisAwarenessMonth observed each year in March, as it provides an opportunity to raise awareness of both this disease and the available treatments for it symptoms, including infertility.

Approximately 176 million women in the world suffer from endometriosis -a condition that occurs when the tissue that normally lines the inside of the uterus, called endometrium, grows on other parts of the body, such as the bowel, bladder, rectum and intestines, as well as on the ovaries, fallopian tubes and the outside of the uterus.

What causes endometriosis?

What exactly causes endometriosis is not known, but a number of risk factors that make certain women more likely to develop it, such as a family history of endometriosis; being overweight; having had your first period at an early age (ie before the age of 12); as well as having heavy or extended periods.

Speaking at a recent IFAASA webinar, Dr Tony Rodrigues – a reproductive medicine specialist and a founder and director of Medfem Fertility Clinic – explained as follows: “During menstruation, the blood from the uterus not only comes out vaginally, but some of it goes down the fallopian tubes. This blood contains what we call endometrial cells and these cells, that look exactly like menstrual blood, end up deep in the pelvis, because the little fallopian tubes are pointed downwards, and they drain into the lower pelvis.
“If the immune system doesn’t clear these endometrial cells within a very predetermined time, the body fails to recognise these cells as things that should not be there. Another immune system – called the cellular immune system – kicks in and allows these benign tumours of cells to grow in the abdomen.”

Some women have a few isolated implants that don’t grow bigger and never spread. For other women, endometriosis can spread throughout the pelvis and can be present in varying degrees. Depending on the amount, location and depth of the endometriosis it may be classified as minimal (Stage 1), mild (Stage 2), moderate (Stage 3), or severe (Stage 4).

What are the symptoms of endometriosis?

Many women who have endometriosis experience few or no symptoms. In other women, however, endometriosis may cause a wide range of debilitating symptoms such as pelvic, abdominal and back pain, heavy and painful periods, severe menstrual cramps, pain during intercourse, as well as other symptoms such as infertility.

How does endometriosis affect fertility?

Around 30% of women with infertility problems have endometriosis. This because endometrial tissue can cause an inflammatory reaction in the pelvis, which affects the various reproductive process, from egg development and ovulation to fertilisation, embryo travel through the fallopian tube, and implantation in the uterus.

Some of the ways in which endometriosis can affect fertility include:

– scarring and adhesions that distort the anatomy of the pelvis;
– inflammation of pelvic structures;
– scarred, blocked or damaged fallopian tubes;
– damaged ovaries;
– changes in the hormonal environment of the eggs;
– altered egg quality; and
– impaired implantation of embryos.

Thankfully, having endometriosis does not invariably mean that you will be unable to fall pregnant. While the stages of endometriosis correlate with infertility, and women with severe endometriosis often require advanced fertility treatment, as many as 70% of women with endometriosis are still fertile. In addition, about half the women with endometriosis who have difficulties with getting pregnant do eventually conceive with or without treatment.

How is endometriosis diagnosed?

Endometriosis is rarely diagnosed from the symptoms. This is because the symptoms of endometriosis are similar to many other common conditions, which often leads to it being undiagnosed or misdiagnosed, causing a significant delay before it is treated.

At Medfem Fertility Clinic, we often test the cervical mucus, because we have found over the last six years that that every patient with poor mucus will have underlying endometriosis as well.

The most accurate way however to diagnose endometriosis is through a laparoscopy, which is a type of minimally invasive surgery that involves a small telescope-like instrument that is inserted through a small incision under the belly button to examine the pelvic organs while a patient is under anaesthetic.

A laparoscopy allows a fertility specialist to confirm the presence of endometriosis as well as to assess the severity of the condition. During the procedure, a small piece of tissue can also be removed for a biopsy (microscopic examination).

Treatment of endometriosis when TTC

While there is no known cure for endometriosis, it can be treated very effectively through either surgery or medication, although some patients need a combination of medical and surgical treatment.

When trying to conceive (TTC), it is important to work with a fertility specialist who will focus on managing the endometriosis to truly improve future fertility outcomes.

Says Dr Rod: “From our experience at Medfem Fertility Clinic, spanning the last 30 years, if a patient has a few spots of endometriosis, and no other fertility challenges, treating the endometriosis can restore fertility and result in a pregnancy.”

Usually for fertility patients, endometriosis is treated surgically at the time of the laparoscopy performed for diagnosis. Deposits of endometriosis can be removed or destroyed laparoscopically and scar tissue can be removed.

However, sometimes, medication can be used to inhibit the endometriosis in the short term, to reduce acute inflammation before IVF treatment.

“At Medfem Fertility Clinic, our clinical experience over 30 years have also led us to believe that endometriosis is a stress-related condition,” says Dr Rod. “It is not that stress causes endometriosis, but stress definitely affects the immune system, which allows the cells to grow in the abdomen. There’s no question in my mind that stress management improves the prognosis in endometriosis, as we have seen many patients practicing stress management as part of their preparation for IVF falling pregnant naturally before the IVF, because reduced stress improves the immune system.”

Where to get treatment for endometriosis when TTC?

If you are suffering from endometriosis, and it is affecting your fertility, we would like to invite you to meet one of our fertility specialists.

Medfem Fertility Clinic employs safe and proven methods to establish a clear diagnosis of endometriosis. The treatment recommended is highly individualised for each patient.

Medfem Fertility Clinic is also one of the first institutions in South Africa to have developed a fully comprehensive operating theatre with all the necessary equipment to perform procedures such as laparoscopies. In fact, our facilities are a centre for advanced laparoscopy. Our state-of-the-art theaters are fully equipped and specially designed and the specialists at Medfem Fertility Clinic have also all undergone extensive training abroad and are experts in performing laparoscopies.

Simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244. Our Fertility Specialists can also meet with You During a Virtual Consultation Via Zoom or Skype. Click here to book a virtual consultation now.
We look forward to meeting you at Medfem Fertility Clinic!

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