Endometriosis and Pregnancy: What Women Need to Know
An Endometriosis Fertility Index is used to identify the women who may benefit from artificial reproductive techniques like IUI, OI or IVF after surgery
Endometriosis is a complex and often misunderstood condition that affects one in 10 women approximately around the world. It’s characterised by the growth of the tissue that lines the inner lining of the uterus (endometrium) outside the uterus. It mainly involves the ovaries, which can form cysts, commonly called chocolate cysts or endometriomas in more medical terms. In rare cases, such cysts are also found in a woman’s intestines or urinary bladder. Excessive pain is a common symptom of endometriosis. Depending on where the endometriosis has spread in the body, it can also cause discomfort and pain in the lower abdomen. Dr Adarsha Kalapala, Consultant, Obstetrics and Gynaecology, Fernandez Hospital shares all you need to know:
Endometriosis and Its Effect on Conception and Pregnancy
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Connections have been made between infertility and endometriosis. Around 30% of women with endometriosis have difficulty conceiving. The reasons for the struggle could be factors like a decreased egg supply or blocked fallopian tubes. It affects up to 30% of the women who experience infertility. Not all women with endometriosis are infertile. Since it’s a progressive disease, your gynaecologist may advice you to plan for pregnancy earlier to reduce risks.
How is Fertility Assessed in Women with Endometriosis
When trying to get pregnant, such women need to be evaluated on their egg supply, quality, condition of uterus and fallopian tubes. The evaluation is done by physical examinations, ultrasounds and blood tests, including the Anti-Müllerian Hormone test which is used to check the number of eggs available. If any abnormalities are found in the woman’s fallopian tubes, tests like Hysterosalpingogram (HSG) and Saline Infusion Sonography (SIS) are suggested to check if the tubes are blocked or open. If all the reports come back normal, your gynaecologist may recommend trying to conceive naturally for six months.
Treatment Options
Endometriosis can be treated medically and surgically. As per the European Society of Human Reproduction and Embryology (ESHERE) guidelines (2022), the medications prescribed to slow the progression of endometriosis does not improve fertility. If surgery is required to remove a large cyst, women should be made aware that this can reduce their ovarian reserve.
An Endometriosis Fertility Index is used to identify the women who may benefit from artificial reproductive techniques like IUI, OI or IVF after surgery. Ovulation induction (OI) and Intrauterine Insemination (IUI) has shown good results for women with grade 1 or 2 endometriosis. In Vitro Fertilisation (IVF) has proven useful for women with grade 4 endometriosis or in conditions where patency of fallopian tubes is compromised. Sometimes, surgery is required before IVF to gain access to the ovaries for egg retrieval.
Can you Preserve Fertility with Endometriosis?
For women with endometriosis, fertility preservation options like egg or embryo freezing are a good idea. However, they are not routinely offered by doctors.
What to Expect when Expecting?
When pregnant with endometriosis as a pre-existing condition, serious complications related to this condition are rare. Pregnancy helps reduce the pain and other symptoms of endometriosis as pregnancy hormones change the endometrial tissue. However, post-delivery, you may notice the symptoms of endometriosis gradually return.
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