A: Among women with fertility problems, endometriosis may occur in as many as 50 percent.
But exactly how endometriosis causes infertility is not clear. Some evidence suggests that infertility is related to the extent of the endometriosis patches, because the patches can distort the pelvic anatomy. This would make it difficult for sperm to travel to the ovary or a fertilized egg to travel to the uterus. Other evidence suggests inflammation in the abdomen may disrupt ovulation or fertilization, or that the endometrium may not develop properly, hampering the attachment of the embryo to the uterus.
Fortunately, there are treatments for endometriosis-related infertility that may help women get pregnant, even if they have endometriosis:
In most cases, health-care providers recommend laparoscopy to remove or vaporize the growths as a way to improve fertility in women who have mild or minimal endometriosis. Studies show improved pregnancy rates after this type of surgery, but the success rate is not clear.
If pregnancy does not occur after laparoscopic treatment, in vitro fertilization (when sperm and eggs are combined in a laboratory to make an embryo. The resulting embryos are placed into the woman’s uterus) may be the best option to improve fertility. Taking any other hormonal therapy usually used for endometriosis-associated pain will suppress ovulation and delay pregnancy, and a second laparoscopy is not the preferred approach to improving fertility unless symptoms of pain prevent undergoing IVF. Multiple surgeries, especially those to remove cysts from the ovaries, may reduce ovarian function and hamper the success of IVF.
Even though the use of hormones in IVF can be successful in treating infertility-related to endometriosis, other forms of hormone therapy are not as successful. For instance, the American College of Obstetrics and Gynecology does not recommend using oral contraceptive pills or GnRH agonists to treat the condition. The use of these hormonal agents prevents ovulation and delays pregnancy.
In addition, the hormones used during IVF do not cure endometriosis lesions, which means pain may recur after pregnancy, and not all women with endometriosis will be able to become pregnant with IVF. Researchers are still looking for hormone treatments for infertility due to endometriosis.
Black women are no more likely to suffer infertility than their white counterparts, but studies show we are more likely to believe we’re alone with this problem and to feel shame.
I Have Endometriosis. Can I Get Pregnant?
