Endometriosis causes infertility in 30 to 50 percent of cases. The exact mechanisms aren’t well understood, especially in cases where the extent of the disease is low. The most obvious cause is that endometrial lesions in the linings of the fallopian tubes block the eggs from traveling to the uterus, which is necessary for conception to occur.
However, more complex reasons for infertility due to endometriosis also exist. For example, endometriotic cysts can release various chemicals that reduce the likelihood of conception, including free iron, proteolytic enzymes, chemicals containing reactive oxygen, and those that cause inflammation. Furthermore, endometriotic cysts reduce the density of follicles in the ovaries, which reduces fertility. This reduction appears to be greater than expected if it were merely due to the stretching of tissue surrounding a cyst.
Some primary care physicians recommend that patients with endometriosis see an infertility specialist before they even attempt to become pregnant. These specialists can conduct tests such as an anti-mullerian hormone (AMH) test to determine the patient’s remaining egg supply, known medically as the ovarian reserve. The primary reason for this practice is that surgical treatments for endometriosis can reduce the patient’s ovarian reserve. Even diagnostic surgeries for endometriosis can affect fertility by causing scars.
While it’s always a good idea to live as healthy a lifestyle as possible when trying to conceive, it’s especially important to do so when your fertility is compromised. These practices help reduce the inflammation that endometriosis can cause, making a healthy pregnancy more likely.
Maintaining a healthy body weight is critical for conception, which should involve a combination of diet and exercise. Your diet should be high in fruit, vegetables, whole grains, and sources of lean proteins. Moderate exercise each day is also vital, which should primarily consist of aerobic activities such as walking, running, and cycling.
Age is also an important factor when you have endometriosis and are trying to get pregnant. In particular, fertility begins to drop after the age of 35.
Treatments for endometriosis-related infertility include freezing the patient’s eggs for future use. Endometriosis can reduce the ovarian reserve, so many doctors recommend this course of action as a precaution against running out of eggs. However, this option is expensive, as most health insurance policies don’t cover it. Additional treatments include superovulation and intrauterine insemination (SO-IUI), which is most common for patients with normal fallopian tubes and only mild endometriosis. Fertility specialists may also prescribe medications such as Clomiphene and progestin to encourage the release of multiple eggs during ovulation.
In vitro fertilization (IVF) is another option, typically for women with moderate to severe endometriosis that hasn’t responded to other treatments. This procedure involves extracting an egg from the patient and fertilizing it with the partner’s sperm outside the body. The success rate of IVF for patients with endometriosis is less than 50 percent.
For more information, please visit our complete Endometriosis Guide.