Endometriosis and Infertility


Endometriosis is a common condition that affects up to one in ten women during their reproductive years.

In this article we find out what endometriosis is and who it affects, what symptoms it produces and how it affects fertility, as well as how to find out if you have endometriosis, what treatments are available and where to find the right treatment for you.

What is endometriosis?

Endometriosis occurs when the tissue that normally lines the inside of the uterus, called endometrium, grows on other parts of the body, including the bowel, bladder, rectum and intestines, as well as on the ovaries, fallopian tubes and the outside surface of the uterus.

Endometriosis irritates surrounding tissue, causing pain and producing web-like growths of scar tissue called adhesions. This scar tissue can bind any of the pelvic organs to one another and can even cover them entirely. In addition, because this endometrial tissue behaves the same way as that found in your uterus, it responds to hormonal changes during menstruation, causing it to break down and bleed into the surrounding area.

Endometriosis found on the ovaries can also form cysts. These cysts bleed during each period, and if not all of the fluid drains away, the old blood builds up to create a ‘chocolaty’ appearance, from which the name ‘chocolate cysts’ derives.

Who is affected by endometriosis?

Endometriosis affects 10% of women, from teenage girls to women in their 40s. What exactly causes endometriosis is not known, but it has been found to run in families.

There are also a number of risk factors that make certain women more likely to develop endometriosis. These include 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.

Endometriosis is also more likely to be found among women who have never been pregnant. Because working women often delay pregnancy, endometriosis is sometimes called the “career woman’s disease”. However, this is misleading, as endometriosis also affect women who have already had children.

What are the symptoms of endometriosis?

Endometriosis is not predictable. Some women have a few isolated implants that don’t grow bigger and never spread. For other women, endometriosis can spread throughout the pelvis.

Similarly, many women who have endometriosis experience few or no symptoms. In other women, 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.
Endometrial tissue can cause an inflammatory reaction in the pelvis, which has been shown to affect the reproductive process at various stages, 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.

Fortunately, while endometriosis is a known cause of infertility, it is possible to become pregnant even if you have endometriosis. There are well established and effective medications and procedures available to assist you in falling pregnant.

How will I know if I have endometriosis?

Because many women who have endometriosis experience few or no symptoms, the condition is often only diagnosed when a patient is undergoing pelvic examinations or surgery for other reasons.
Tenderness in the pelvic region, a fixed or immobile uterus and enlarged ovaries may all indicate the presence of endometriosis, as could symptoms such as severe menstrual cramps, pain during intercourse and fertility problems.

However, a diagnosis of endometriosis cannot be based on the symptoms alone.

The most accurate way to diagnose endometriosis is through a laparoscopy. Laparoscopy is a type of minimally invasive surgery that is used with great success in the diagnosis and treatment of many medical conditions that cause infertility. This procedure 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 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).

Your specialist will evaluate the amount, location and depth of endometriosis to determine if your endometriosis is minimal or Stage 1, mild or Stage 2, moderate or Stage 3, or severe which is Stage 4. The stages correlate with infertility, and women with severe endometriosis often require advanced fertility treatment.

What treatment options are available?

Because endometriosis manifests in varying stages of severity, the treatment must be tailored for each individual, considering each patient’s history, symptoms and the clinical findings of the laparoscopy.

Treatment can either be surgery or medication. Some patients need a combination of medical and surgical treatment.

Usually, 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.

Because endometriosis requires estrogen to grow, birth control pills and other medications that lower or block estrogen can also be used to improve pain symptoms. For women who are trying to achieve a pregnancy, this is not the ideal option, but it could be considered as a step before fertility treatments commence.

Endometriosis patients who are also trying to fall pregnant are treated with specific stimulation protocols. Ovarian reserve tests are done to determine how aggressive the fertility treatments should be. Great emphasis is placed on avoiding any damage to healthy ovarian tissue and possible deterioration of ovarian reserve.

Should a patient with endometriosis not conceive after medical and surgical treatment, in-vitro fertilisation may be an option. The optimal period for falling pregnant via IVF when suffering from endometriosis is between six months to one year after the surgery.

Where can I get treatment for endometriosis?

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.

If you are suffering from endometriosis, or are affected by the symptoms such as infertility, we would like to invite you to meet one of our fertility specialists.

At Medfem we believe in helping you reach your family dream through:

* World-Class Fertility for Everyone – we believe in making world-class fertility treatments available for everyone
* A Positive Fertility Journey – It is our joy and commitment to give you a positive outcome to your fertility journey
* Delivered With Empathy & Caring – So you may have a fond memory, of a feeling of empathy, caring and being part of the Medfem family.

Simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.

We look forward to meeting you at Medfem Fertility Clinic!


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