CanIGetPregnantwithEndometriosis?PublishedonSeptember18,2018
byhttps://blog.scrcivf.com/author/scrc-contributorSCRCContribut
orEndometriosisisoneofthemostcommoncausesoffemaleinfert
ility,anditaffectsupto10%ofwomenofchildbearingage,acc
ordingtothehttps://www.nichd.nih.gov/health/topics/endometri/c
onditioninfo/Pages/at-risk.aspxNationalInstituteofHealth.Asi
ftheextremechronicpainandheavybleedingthatendometriosis
cancausewerenotenough,itcanalsoseriouslyderailyourplan
stogetpregnant.Ofthemorethan5millionAmericanwomencopi
ngwithendometriosis,atleastathirdmustalsodealwithitsi
mpactontheirfertility.Ifyouhavebeendiagnosedwithendometr
iosisandaretryingtogetpregnant,whatareyouroptions?Gett
ingagoodunderstandingofendometriosisanditscomplicationsi
sasmartfirststep.We’veputtogetherthisguidetogettingpr
egnantwithendometriosissothatyoucanfeelempoweredtotalk
toyourdoctoraboutpossiblenextsteps.Whatisendometriosis?ht
tps://www.scrcivf.com/treatment-options/surgical-fertility-treatm
ents/minimally-invasive/endometriosis/Endometriosisisagynecolo
gicalconditionwherecelltissueverysimilartotheendometrial
tissue(endometrium)whichformstheuterineliningisfoundgro
wingoutsideoftheuterus.Therearemanydifferentnamesforth
esebitsofendometrial/endometriotictissue,including:LesionsIm
plantsPlaquesEndometriomasEndometrialdepositsgrowanywherein
thepelviccavity,includingonandaroundthereproductiveorgan
s.Theycanalsosometimesbefoundoutsidethepelviccavity,in
theintestines,appendixandrectum.Theselesionscanbleeddur
ingthemenstrualcycle,causinginflammationandscarring.Thesy
mptomsofendometriosiscanbeveryunpleasantanddisruptive,an
dinclude:PelvicpainLowerbackpainHeavyandirregularmenstrual
periodsPainduringintercoursePainanddiscomfortwithbowelmov
ementsOvariancystsInfertilityAnofficialdiagnosisofendometrio
sisisusuallygivenafteralaparoscopy,wheretheplaquescanb
eseenandidentified.Theconditionisclassedinto4stagesas
itprogresses.I-minimalII-mildIII-moderateIV-severeThecl
assificationsarebasedonthelocation,number,sizeanddeptho
fendometrialimplants,whetherthereisscartissueandhowexte
nsiveanyscarringis.Thestageofendometriosisisnotconnecte
dtotheamountofpainapatientexperiences:awomanwithstage
IorIImayhaveexcruciatingpainwhileonewithstageIVexper
iencesverylittlediscomfort.Similarly,thelevelofyourpain
doesnotindicatewhetheryouaremoreorlesslikelytoexperien
ceinfertility.Infertilitycanhappenatanystage,althoughitd
oesseemtoincreasewiththeseverityofthecondition.Whenlef
tuntreated,endometriosistendstogetworseovertimeastheen
dometriomasgrowandmultiply,butthisvarieswidelybetweenpat
ients.Thereisnocureforendometriosis,buttherearetreatment
savailabletohelpmanagethesymptoms.Howcanendometriosisaff
ectmyabilitytoconceive?Endometriosisisacomplexdisease,th
ecausesofwhicharestillnotwellunderstood.Whatisclear,h
owever,isthatitcausesalotofsufferinginthewomenwholiv
ewithit,andthatitcanhaveasevereimpactontheirability
togetpregnantwhentheywantto.Theresearchsaysthatbetween
30%to50%ofwomendiagnosedwithendometriosisalsostrugglew
ithinfertility.Thechanceofawomanwithuntreatedendometrios
isconceivingeachmonthisjust2-10%,comparedto15%-20%inth
egeneralpopulation.Itisnotalwayseasytodiscoverhowendome
triosisiscausinginfertilityforaspecificpatient,butthere
areseveralwaysthatitcancomplicatenaturalconception:Pain:?
Severepelvicpainisoneofthemostsignificantsymptomsofend
ometriosis,andunfortunately,mostofthetreatmentsthathelpa
reincompatiblewithpregnancy.Birthcontrolpills,IUDs,andot
herhormonaltreatmentsareoftenusedtoslowthegrowthofendo
metrioticdeposits,whichcanreducepainandrelievetheheavyp
eriodscausedbyendometriosis.Ifyouwanttogetpregnant,you’
llhavetostopthesetreatments,whichcouldleadtoyoursevere
symptomsreturning.Painduringintercourseisalsoacommonsym
ptomanditcangetworseinthetimeperiodthattheendometrios
isisuntreated,whichcanmakeitmoredifficulttoconceivenat
urally.Adhesions,scarring,andblockages:?Whendepositsfromend
ometriosisformaroundreproductiveorgans,theycanaffecttheir
functioning.Oneofthemorecommonfertilityissuesdealtwith
bywomenwithendometriosisisanobstructionorblockageinone
orbothfallopiantubes,whichcaninterferewithnormalovulatio
nandpreventconception.Ovariancystsandcomplications:?Endomet
riosiscancause“chocolatecysts”(namedaftertheirdistinctive
darkbrowncoloring)togrowontheovaries.Thesecystscandis
ruptovulation,impedebloodflowtothevary,blocktheregular
transportationofeggsfromovarytofallopiantube,affecttheq
ualityoftheeggs,orevencausestructuraldamagetotheovarie
sandreduceovarianreserve.Anyoftheseissuescancauseinfer
tility.Endometrioticdepositscausingtoxicityinthepelvic(int
raperitoneal)environment:?Eveniftherearenoblockages,adhesi
ons,orcystsaffectingovulation,relativelymildcasesofendom
etriosiscanstillleadtounexplainedinfertility.Researchersa
restudyingwhythismightbe,andearlyevidencesuggeststhatc
hemicalchangesinthebodyduetothepresenceofendometriosis
maybetoblame.Itmaybethattheendometrialcellsoranimmun
eresponsetothosecellsareproducingbiochemicalsubstancessu
chasprostaglandinswhichcouldbemakingtheintraperitonealen
vironmenthostiletofertilizationandembryoimplantation.Remova
lofreproductiveorgans:?Inveryseverecasesofendometriosis,
oriftheendometriosiscausesirreparablescarringanddamageto
thereproductiveorgans,apatientmayhavesurgerytoremoveth
eirovariesand/oruterus.Thishasobviousconsequencesforfert
ility.Dependingonthetimingofthissurgeryandwhatwasremov
ed,theremaystillbestepswhichcanbetakentomakehavinga
babypossible,whichcouldincludefreezingeggsbeforetheproce
dure(fertilitypreservation),usinganeggdonor,and/orusinga
surrogate.Whattreatmentscanhelpmegetpregnantwithendometr
iosis?Ifyou’replanningtogetpregnantorifyou’vebeentrying
forsometimewithoutsuccess,don’twaitbeforeseekinghelp.F
ormostpatientswithendometriosis,timeisanimportantfactor.
Theconditionisprogressive,andthesooneryoucangetpregnan
t,thebetter.Anytriptothedoctortotalkaboutyourfertility
shouldbeginwithafullfertilityworkup.Thereareahttps://b
log.scrcivf.com/fertility-tests-for-women-how-do-you-test-your-fe
rtilitywiderangeofdiagnosticfertilitytestsavailablewhichc
anshedlightonwhatmaybehappeninginsideyourbodythat’spr
eventingyoufromgettingpregnant.Armedwiththisinformation,
yourfertilityexpertcanworkwithyoutodrawupatreatmentpl
anthatmakessenseforyouruniquecase.Thegoodnewsisthatth
ereishelpoutthereforwomenwhowanttogetpregnantinspite
ofendometriosis.Medication,surgery,andassistedreproductive
therapies(ART)havemadeadifferenceforthousandsofpatients
dealingwiththisdebilitatingdiseaseandallowedthemtoachie
vetheirdreamofahealthypregnancyandbirth.GnRHagonistsbef
orefertilitytreatment:?GnRHagonistmedicationsareacommontr
eatmentforendometriosiswhichhasbeeninuseforalongtime.
GnRHstandsforgonadotropinreleasinghormone,whichisanatura
llyoccurringhormonethatworkstocontrolthemenstrualcycle.
GnRHagonistsaremodifiedversionsofthesamehormone.Theysup
pressthebody’sproductionofestrogen,whicheffectively“starv
es”theendometrialdeposits,stopsthemfrombleeding,andcause
sthemtoshrink.YoucannotgetpregnantwhiletakingGnRHagoni
sts,butstudieshaveshownthatacourseofGnRHtreatment(usua
lly3to6months)beforeundergoingfertilitytreatmentcansign
ificantlyimprovesomepatients’chancesofsuccess.Surgery:?Surg
erytoremovedeposits,lesions,andplaquescausedbyendometrio
sismaybeanoption.Itisoftenpossibletoclearablockedfal
lopiantube,andsomestudiesreportthat30%to80%ofwomenwho
undergosurgeryforendometriosiseventuallygetpregnant.Buta
tthispointtheevidenceisunclear.Successratesappeartobe
directlytiedtotheseverityofthediseaseandtheageofthep
atient.Insomecases,surgicalinterventioncouldmakethesitua
tionworsebycausingscartissueordiminishingovarianreserve.
Youngpatientswithadvancedendometriosisandalotoflargeen
dometriosismaybenefitthemost.Intrauterineinsemination(IUI)
withcontrolledovarianstimulation(COH):?IUIcombinedwithhorm
onalfertilitymedicationcanhelpinsomecasesofmild/moderate
endometriosis,whenthepatientdoesnothaveanyblockagesand
isabletoovulate.Researchhasshownthatthecumulativeliveb
irthratewasfivetimeshigherafterIUI-COH,thoughstilllower
thanforpatientswithoutendometriosisbyabout21%.IVF:?https:
//blog.scrcivf.com/endometriosis-and-infertility-is-ivf-a-good-fe
rtility-optionInVitroFertilization(IVF)isoftenthebestopti
onforwomenwithendometriosis,especiallyiftheyaredealingw
ithobstructionstoovulation.UndergoingIVFisanextremelyeff
ectivetreatmentforendometriosispatientsandtheprognosisis
generallyveryencouraging.Inourpractice,theIVFpatientswe
treatwhohaveanendometriosisdiagnosisusuallydojustaswell
asthosewithoutit.Howcouldendometriosisaffectmypregnancy?
Mostpatientsgoontohavehealthypregnancies,butyoushouldb
eawarethatstudieshaveshownthatendometriosisisariskfact
orforsomecomplications,including:MiscarriageHighbloodpressu
re(preeclampsia)Bleedingafter24weeksLow-lyingplacenta(plac
entaprevia)CesareansectionPrematurebirthWhilethislistmaylo
okintimidating,weshouldnotethatresearchonthesetopicsis
stillintheearlystages.Whiletherearesomeassociationsbetw
eenendometriosisandcomplications,thelinksarenotfullyunde
rstood.Thebestthingyoucandoduringyourpregnancyistoens
urethatyougetregularprenatalcare.Don’tworrytoomuch.The
bottomlineis:gettingpregnantandcarryingahealthybabyto
termisacommonoutcomeforwomenwithendometriosis.Endometrios
iscannotbetreatedduringpregnancy,butmanywomenactuallyfi
ndthatgettingpregnantgivesthemsomerelieffromtheirsympto
msforthedurationofthepregnancy,andoftenforasubstantialperiodafterwards.Livingwithendometriosisishard.Soisinfertility.Alongwiththephysicalsymptoms,theemotionalfalloutofhavingtocopewitheverythingendometriosisbringscanbeintense.It’ssoimportanttohaveastrongsupportsystemandateamthatunderstandsyourconditionandwhatyou’redealingwith.IfyoudodecidetoundergoIVF,yourfertilityexpertshouldknowthatparticularlycarefulmedicationmanagementisnecessaryduringtheovarianstimulationphaseoftreatment,asitmaycauseatemporaryincreaseinendometriosissymptoms.Aboveall,youshouldknowthatyouarenotaloneasyouwalkthisroad.Somanywomenhaveovercomethisconditiontobringhometheirbaby.Withtherighthelp,anythingispossible. |
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