A common disorder that causes pain and bleeding can also make it hard to get pregnant
March 2, 2018
By Laura Schumacker
- Endometriosis is a pretty common condition characterized by pain, urinary or bowel issues, and more, but some people don’t have any symptoms at all.
- For some people who have endometriosis, it can be difficult to try to get pregnant.
- Hormonal treatments and surgery are both options for those struggling with endometriosis and infertility.
Endometriosis is a chronic condition that affects many people.
For those who struggle with the disorder, the endometrium — the tissue that normally lines the outside of the uterus — grows outside of the uterus and becomes displaced in other parts of the body such as the fallopian tubes and pelvic organs.
Resolve, The National Infertility Association, estimates that about 10 percent of American women and more than 176 million women worldwide have endometriosis. And while many experience symptoms like pain and excessive bleeding, some don’t have any symptoms at all.
For some of those with endometriosis, conceiving can be quite difficult. “The key to dealing with any form of infertility is diagnosing infertility,” Brian A. Levine, MD, a fertility expert and founding partner and practice director of CCRM New York. “This means that if a woman less than 35 has been trying to conceive for more than one year, or a woman over 35 has been trying to conceive for more than six months, they should seek an evaluation by their OB-GYN or a reproductive endocrinologist.”
If you’ve been diagnosed with infertility and endometriosis, the best ways to address the infertility and — hopefully — get pregnant will depend on the severity of your endometriosis, Levine said.
Finding a treatment team is essential.
“The relationship between endometriosis and infertility remains complex and not completely understood. The disease can impair and interfere with the reproductive process on many levels, ranging from mechanical to molecular,” Heather Guidone, the surgical program director at the Center for Endometriosis Care and an endometriosis expert, told INSIDER.
Finding an OB-GYN and/or a reproductive endocrinologist who believes they’ll be able to find the right solution for you and help you get pregnant — if that’s what you’re hoping for — can be an important part of the process.
“While there is no universal approach for every affected individual, early intervention and integrated care with a skilled, multidisciplinary team can be essential,” Guidone, who herself is an endometriosis patient, said. “Those centers of expertise or collaborative networks that focus on the disease as a specialty have the teams and referrals in place to personalize the individual’s care. A patient-centered approach can optimize outcomes in many cases, by facilitating engagement between the patient and various experts, ranging from surgeons to reproductive specialists.”
Hormonal treatments and surgery are both options for those struggling with endometriosis and infertility.
Medical interventions for endometriosis and infertility range from surgeries to in vitro fertilization (IVF) or even a combination approach. Again, it depends on your specific circumstances and how extensive your endometriosis might be.
“I have been told by infertility specialists that removing endometriosis/adhesions may increase the chance of getting pregnant in the women that are having difficulty getting pregnant,” Dr. John F. Dulemba, MD, FACOG, an endometriosis and pelvic pain specialist at The Women’s Centre. “That is why surgery is so important. Hormonal treatments may not have a role in this aspect.”
If you and your healthcare providers decide that surgery is the best next step for you, there are still some things you might want to know.
Make sure to talk to your doctor about what kind of surgery is best for you before undergoing any procedures.
“If surgery is required, the surgeon should have advanced surgical training in minimally-invasive techniques, and should have the support from other surgical teams in the event of a complication of surgery,” Levine said.
Beyond ensuring that the surgeon is a specialist, you’ll probably want to know more about the details of the procedure and techniques that will be used, themselves.
“In our center, for example, we utilize the C02 laser as a cutting tool, whereas others may use it to vaporize those very delicate tissues. This is neither a realistic nor effective long-term approach to the disease, as vaporization leaves endometriosis behind and damages the tissue,” Guidone said. “By contrast, use of C02 laser energy in an excisional manner allows for precise, gold-standard surgical treatment, which removes endometriosis and preserves healthy tissue and organs, thereby restoring — or preserving — fertility a great deal of the time.”
Working with expert healthcare providers to address your endometriosis is important at all stages of your life, even if you’re not trying to conceive. Some of the condition’s other symptoms can be just as necessary to address.
“More women suffer from the pain of endometriosis and adhesions than have a difficult time getting pregnant, but both aspects interfere with women’s lives on a daily basis around the world,” Dulemba said. “This disease is so under recognized.”