Endometriosis—defined as endometrial-like tissue that implants in areas outside of the uterus— affects up to 1-in-10 reproductive-aged women. Endometriosis can cause pelvic pain, and some women with endometriosis may have difficulty conceiving, with 30-50% of women with endometriosis presenting with infertility.
How can endometriosis affect fertility?
There are several ways in which endometriosis can impair fertility. Chronic inflammation can negatively affect oocyte (egg) quality, fallopian tube function, and/or implantation. In more advanced cases of endometriosis where scar tissue has also formed, pelvic anatomy can be distorted, making it harder for the egg and the sperm to meet.
Fertility Treatment Options
Treatment of endometriosis-related infertility depends on the severity of endometriosis.
In woman with mild endometriosis, ovulation induction with intrauterine inseminations is recommended, and does increase fertility rates. However, ovulation inductions cycles should be limited to no more than 4 cycles given that each cycle can stimulate endometriosis growth/endometriosis-associated pain. Surgical treatment of endometriosis can increase the chances of conceiving spontaneously, but whether or not this is the right treatment for you should be discussed with your reproductive endocrinology and infertility specialist.
In vitro fertilization is the most effective treatment for endometriosis-associated infertility, especially in women with severe endometriosis compromising the fallopian tubes and in women with diminished ovarian reserve. Pre-treatment with leuprolide acetate (a medication that suppresses endometriosis) for 3 months is recommended to help optimize in vitro fertilization outcomes.
While expectant management is an option, it is usually not recommended. This is because the cycle fecundity (the likelihood of becoming pregnant with unprotected sexual intercourse in a single monthly cycle) is lower in women with endometriosis compared to women without endometriosis.
Getting an assessment
If you know or think you have endometriosis and are interested in becoming pregnant, we recommend scheduling an appointment at our fertility center in La Jolla. Our fertility specialists will gather a complete a history, perform a fertility assessment, and discuss individualized fertility treatment options for you.