1.08 Infertility Causes: Options for Women with Endometriosis

Today we are continuing our series on conditions that can cause infertility, and in our last episode we discussed endometriosis.

So what if you have been diagnosed with endometriosis, but are not ready to be pregnant?

Well any assessment and management of your endometriosis should also address your fertility and reproductive intent. This will usually involve an assessment of your ovarian reserve, which is most simply done by with a blood test called an AMH, an assessment of the severity of your endometriosis and a discussion of your reproductive intent. In conjunction with your specialist team, you will be able to develop a tailored management plan for your fertility based on your disease and your individual situation.

Preserving your fertility for a later pregnancy may involve optimising lifestyle and fine-tuning medical and surgical management. In certain circumstance, particularly if the ovarian reserve is low or the disease is extensive, egg or embryo (fertilised eggs) freezing may be an option. This will involve running an IVF cycle and freezing eggs for future use, should you have problems later. It is important to bring these issues up with your specialist.

Getting pregnant is a slightly different issue as we have discussed, because there are two other important factors: age and sperm.

While your fertility is affected by your endometriosis, equally important is your age when you are trying to get pregnant. A woman in her twenties is very likely to be successful, while a woman in her forties will struggle, regardless of the severity of endometriosis.

For this reason, specialist assessment is usually recommended after 6 months if you are over the age of 35.

Similarly, if there is a problem with sperm, non-assisted conception may be difficult. For this reason, male assessment is recommended early in the journey to pregnancy if you have been diagnosed with endometriosis.

If you have not used any contraception for 6 months but have not fallen pregnant you should have a conversation with your medical practitioner, regardless of your age. At that point, your practitioner will assess the severity of your endometriosis, your age, ovarian reserve and the health of your partner. This will help you plan the most appropriate course of action, which may then range from optimising your natural fertility to assessment by a specialist and assisted reproduction.

Treatment options for infertility associated with endometriosis are centred around surgery or medical treatment. Surgery has been shown to increase your natural chances of conception, but appears to have a more limited impact on high level interventions, such as IVF. More importantly, repeat surgery has a limited role in the management of 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.

So, if you are having problems falling pregnant, the non-surgical alternatives then involve assisted reproduction, which may be as simple as artificial insemination or more complex, like IVF. This will really depend on your specific circumstance and your endometriosis specialist will be able to guide you in your decisions.

So the take home message is that while the current evidence suggests that women with endometriosis are more likely to experience fertility problems, not all women will endometriosis will need assistance and only a small number of women will ever require IVF.

In the end, your knowledge about your endometriosis will be your best guide to your fertility journey.

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.