In this episode, we are starting on conditions that can cause infertility, and the first of these is endometriosis.
Endometriosis is a condition where tissue similar to the lining of the uterus or womb, called the endometrium, grows outside of the uterus. Most commonly this is in the pelvis. The endometrium is the area of the uterus that responds to hormones and is shed every month, so when this is in places where it’s not meant to be, you can imagine that this can cause problems.
The most common symptoms of endometriosis are pain and infertility. The pain may be with periods, with sex or endometriosis may cause other types of pain, like bowel and bladder pains. Most commonly, these pains are cyclical, but not always.
It is likely that 1 in 10 women are affected by endometriosis, and if you have pelvic pain and infertility, your chances of having endometriosis are almost 1 in 2. Unfortunately, the diagnosis is often delayed. That’s mainly because the diagnosis requires surgery. While your specialist can get an idea that you may have endometriosis based on your history, examination or investigations - like an ultrasound scan or an MRI - the diagnosis is actually based on taking an appropriate tissue sample. This is usually done through key hole surgery.
Endometriosis can affect fertility in a number of ways. Most obviously, as the disease progresses and pelvic damage increases to organs like the Fallopian tubes, the passage of sperm and eggs through the pelvis becomes increasingly difficult.
In the same way, there are changes in the pelvic environment, most likely resulting from endometriosis related inflammation. These inflammatory substances and cells impair the function of both eggs and sperm, fertilization, embryo development and implantation.
There is also increasing evidence that the quality and quantity of eggs in women with endometriosis is affected, though it is not certain whether this is a direct effect of the disease. Egg quantity (the ovarian reserve) can be measured through a pelvic ultrasound or a blood test, called an AMH. While it makes sense that endometriosis in the ovary can have this effect, the current evidence points to a reduction in egg numbers and quality even if the disease is outside of the ovary.
Similarly, the current evidence suggests that the uterus in women with endometriosis seems to function differently. There appears to be a reduction in implantation and also, based on the most recent analysis, an increased chance of miscarriage in women with endometriosis.
Unfortunately, many of the treatments for endometriosis, whether they be medical or surgical, will also affect fertility. Almost all medical treatments for endometriosis will interfere with ovulation and therefore stop you from falling pregnant while you are on this treatment. While none of these treatments have long term effects on fertility, any delay in conception, particularly over the age of 35, will naturally reduce the chances of conception.
Finally, but most importantly, the pain associated with endometriosis can affect all aspects of relationships, whether directly related to sex or not. Women with endometriosis are more likely to report an altered body image, describe reduced desire, arousal and pain with sex. This pain may not only occur during sex, but will often typically persist for some time afterwards.
So, between the physical effects of endometriosis, reduced egg number and function, painful sex, taking medication and hormonal therapies, undergoing surgery and dealing with a variety of emotional issues, it is little wonder that fertility is affected!
In our next episode, we are going to talk about how endometriosis is treated and what your options are when a diagnosis is made.
Thanks for watching, I’m Anusch Yazdani, the Director of the Fertility Channel. Don’t forget to subscribe to our updates and like us on Youtube.