Endometriosis and fertility – 6 things all women should know

Between 2 - 10 percent of all women in Ireland have Endometriosis, a condition which can affect fertility.

March is Endometriosis Awareness Month, and to shed some light on the condition and how it can affect fertility, we have caught up with Dr. Hani Daabis, Group Medical Director at Sims IVF, to hear what he has to say.

Endometriosis can affect infertility and figures show that between 2 - 10% of women have the condition.  However, it is estimated that 60 – 70% of women with endometriosis are fertile and can conceive without any fertility treatment. Endometriosis may be underdiagnosed and women who may have the condition are often categorised as ‘sub-fertile’, meaning that they have reduced fertility potential.

1. What is endometriosis?

The endometrium is the lining inside the womb.  It is programmed naturally to grow and shed – and that is what happens during menstruation.  Unfortunately, if endometrial tissue forms elsewhere, in the ovaries, for example, there is no way that the tissue can be shed, so it remains and can cause scarring.

2. How does endometriosis affect your fertility?

In the most severe cases, endometriosis can cause tubal damage and make it difficult for sperm to travel through the fallopian tubes, and so preventing the egg and sperm from meeting.

Where endometriosis is present in the ovaries, it can cause ovulatory abnormalities and disturb the regularity of the menstrual cycle. Endometriosis can also cause a decrease in the quality of eggs and their structure.

3. How do you know that you have endometriosis?

First of all, look at your family history - does anyone else in your immediate family suffer from endometriosis? The most common indicator of endometriosis is painful periods, pain during intercourse and pain in the rectum as a result of bowel movements.

4. Investigations recommended?

A scan like transvaginal ultrasound to examine the uterus and ovaries, sometimes ovarian cysts could be seen or MRI to diagnose the severity of extension.

Laparoscopy might be considered, it is the gold standard of diagnosis and excision of the cyst could be done at the same time.

5. What can we do about endometriosis?

If you are not trying for a baby, treatment involves trying to reduce the impact of endometriosis on your life and to reduce its presence in your body. Firstly, you may be put on the pill or advised to have a Mirena Coil inserted. Secondly, you may have a number of operations, which over time could impact your ovarian reserve, affect your fallopian tubes and your womb. Clearly, this approach may not be ideal if you hope to conceive a child in the future but sometimes it is required before proceeding for IVF.

6. What are the fertility options?

In terms of fertility options, treating endometriosis takes a slightly different perspective. There are three main options, which are dependent on the type and severity of your endometriosis. These are: Ovulation Induction (IUI), IVF and Surgery.

If you have Endometriosis and are concerned about your fertility, you should consider booking an appointment with a fertility professional to discuss various treatment methods and find the best way to overcome the problem and conceive.

According to Dr Hani Daabis, when it comes to endometriosis and fertility, it is important to act early.

“Many people conceive naturally with Endometriosis, but if you find that this may be an inhibitor when it comes to conceiving - it is vital to seek help sooner rather than later. A successful outcome for Endometriosis patients undertaking fertility treatment may be achievable”

“It would be a good idea to book in with a fertility specialist to explore your options if you are looking to conceive and overcome endometriosis-associated issues.” Dr Daabis added.