Many women with Endometriosis also suffer from infertility.  Why? Well, that very question spawned today’s research…

It is believed that Endometriosis is present in 24-78% of infertile women (depending on who you ask).  That’s a huge figure! Infertility associated with Endometriosis may occur at any state of the disease (I to IV; mild to severe).  It’s believed that the Stage of Endo may effect the rate of infertility:  people with “mild” Endo have been known to conceive 2-4.5% per month; people with moderate to severe Endo drop to less than 2%.  Normal, fertile couples conceive at a rate of 15-20% per month.  It’s a big difference all across the board.

The medical and scientific community do not have answers as to why Endo may make women infertile; only theories:

• Less intercourse due to painful sex;
• Anatomical distortion caused by implants and/or adhesions;
• Endometriosis may create a toxic environment for fertilization;
• Inflammation may play a role;
• An altered immune system may influence fertility;
• Hormonal changes or imbalance may cause issues;
• Too many surgeries have damaged the girly bits;
• Too much time has passed before diagnosis, allowing the disease to mature and the woman to age, providing an even greater loss of fertility.

There has been no link to the cause and effect of Endometriosis and infertility.  Not yet, at least.

Anatomical Distortion

Chocolate cysts, or endometriomas, are blood-filled cysts that are usually found on the ovaries.  They can also be found outside of the pelvic area (the belly button, brain, liver, etc.); however, these do not seem to affect infertility.  It’s been stated that 17-44% of people with Endometriosis have endometriomas.  These cysts can impede ovulation or even damage the ovaries themselves.  Endometriomas can be removed during an excision surgery; however, as you’ll see, multiple surgeries may cause further damage to the ovary tissue.

On the flip side, a study published in 2015 found that there was no substantial difference between 183 different oocytes (eggs) that came from ovaries that have had endometriomas and those that have not; that the oocytes were not inferior in quality to the healthy oocyte.  So knowing the quality of the eggs was not affected by the chocolate cysts begs to question: is it purely because of any damage to the ovarian tissue or Fallopian tubes that prevents the egg from getting to its Final Destination?

Finally, another 2015 study found that a second surgery to remove an ovarian endometrioma is more harmful to the ovarian reserve and may cause further damage to the ovarian tissue; ultimately affecting fertility.  What is the ovarian reserve?  I had to look it up (thanks wikipedia): it’s “a term that is used to determine the capacity of the ovary to provide egg cells that are capable of fertilization resulting in a healthy and successful pregnancy.”  These findings suggest that repetitive surgeries to excise endometriomas should be done with caution, if at all, for women who are seeking to conceive (either naturally or with medical intervention).

Adhesions may also block an egg from leaving the ovary or block the Fallopian tubes from proper delivery of the egg to the uterus.

Toxic Environment

A study published in 2009 suggests that Endometriosis may create a toxic and infertile environment for sperm.  Byproducts of our inflamed tissues and over-reactive immune system may produce toxic fluids which reach the uterus through the Fallopian tubes.  It concludes, “there was evidence of significantly higher sperm DNA damage in samples incubated with [peritoneal fluid] from patients with endometriosis compared with samples incubated with [peritoneal fluid] from healthy women and controls at the three incubation periods studied…We are proposing that endometriosis-induced sperm DNA damage may be one of the underlying causes of reduced natural fertility in these cases.” More studies, of course, are needed. It’s just frustrating for those EndoSisters who are striving to become pregnant.

Surgery & Fertility Therapy

Assisted Reproductive Therapy (ART) is a common treatment for infertility.  It involves removing the eggs, fertilizing them with sperm in the laboratory, and returning the fertilized egg to the woman’s womb to be carried to term.  According to the CDC, 1.5% of the infants born every year are conceived using the ART technique.

A 2015 study analyzed data which was collected between 1989 and 2014, comparing live births of patients with and without Endometriosis, who had undergone ART.  The figures were comparable for patients with subtle Endometriosis (Stage I and II) and those who did not have Endo, however, unfortunately, it indicated that Stage III or Stage IV Endometriosis have a lesser chance of delivering a successful live birth.  But do not lose hope!

In the 2012 publication Endometriosis: A Guide for Patients, 29% of patients who had their Endometriosis surgically excised were able to conceive within nine months of surgery; as opposed to 17% with Endo who did not have it excised at the time of surgery.  That’s over a 10% difference…

A 2015 French study found that Warriors with Endometriosis who underwent an excision surgery then started fertility treatments or ART had a 78.8% pregnancy rate in as little as 18 months after their surgery!  This study followed 412 patients who had surgery between 2004 and 2012.  They believe the surgical removal of implants and adhesions played a role in improving fertility.

Another 2015 study showed that out of 142 patients trying to get pregnant, 71 conceived naturally after their Endo excision surgeries (5 of these were unplanned) and 38 conceived using ART.  Unfortunately, 38 were unable to conceive either way.  This study concluded that “[w]omen who had surgery to remove stage III-IV endometriosis and subsequently tried to conceive had a 73% chance of pregnancy, the majority within 12 months of index surgery.”

Another 2015 study broke EndoSufferers into groups: some underwent surgery, some had GnRH treatment, and others had in vitro fertilization.  It found that each group had similar numbers when it came to conceiving.  “Pregnancy and delivery rates at different stages of endometriosis were not affected by the different approaches used for infertility treatment…”

Freezing Your BabyMakers

Some may consider freezing their eggs to preserve their lineage.  It’s not unheard of.  Decreased fertility or ovarian function may very well lead you to consider this option.  A study in 2015 stated “[b]ased on the currently available notions on the intricate relationships between endometriosis, infertility and damage to the ovarian reserve, we speculate that fertility preservation may be of interest for women with endometriosis, in particular for those with bilateral unoperated endometriomas and for those who previously had excision of unilateral endometriomas and require surgery for a contralateral recurrence.”  This study concluded by stating further analysis and data are needed before being introduced into routine clinical practices.

What have I learned today

1. Now I know why my surgeon told me that unless I truly wanted to have a child at this point in my life, I needed to use condoms while on Lupron Depot and oral contraceptives afterward.  I had no idea that your chances could improve this drastically after surgery.

2. I’d still like to learn of the link between Endo and infertility…so many theories!

3. But if an EndoWarrior asks me if they can get pregnant after their laparoscopy, I’ll be able to answer that there is a chance they can!  … but there’s also a chance they can’t…

For all of you out there trying to conceive, do not lose hope.

Resources:

American Society for Reproductive Medicine : 2012 (publication) Endometriosis : A Guide for Patients

Unexplained Infertility : 2015 (incomplete Article) Subtle Endometriosis and Unexplained Infertility

Centers for Disease Control and Prevention

Womens Health : 2015 (Abstract) Exploring the Relationship Between Endometriomas and Infertility

Georgia Reproductive Specialists

Biomed Research International : 2015 (Article) The Surgical Treatment of Severe Endometriosis Positively Affects the Chance of Natural or Assisted Pregnancy Postoperatively

Karger : 2015 (Abstract) Pregnancy Rate in Endometriosis Patients According to the Severity of the Disease After Using a Combined Approach of Laparoscopy, GnRH Antagonist Treatment and in vitro Fertilization

Obstetrics & Gynecology : 2015 (Abstract) Influence of Endometriosis on Assisted Reproductive Technology Outcomes: a Systematic Review of Meta-analysis

Human Reproduction : 2015 (Abstract) Fertility Preservation in Women with Endometriosis: For All, for some, for none?

Fertility & Sterility : Article (2009) The Impact of Peritoneal Fluid from Healthy Women and from Women with Endometriosis on Sperm DNA and its Relationship to the Sperm Deformity Index

Fertility & Sterility : 2015 (Abstract) External Validation of the Endometriosis Fertility Index in a French Population

Fertility & Sterility : 2015 (Abstract) Second Surgery for Recurrent Endometriomas is More Harmful to Healthy Ovarian Tissue and Ovarian Reserve than First Surgery

Reproductive Surgery in Assisted Conception : 2015 (Abstract) Endometrioma and Infertility : Principles and Techniques of Management

Reproductive Surgery in Assisted Conception : 2015 (Abstract) Endometriosis and Infertility

Assisted Reproduction Technologies: 2015 (Abstract) Laparoscopic Excision of Ovarian Endometrioma Does Not Exert a Qualitative Effect on Ovarian Function: Insights from in vitro Fertilization and Single Embryo Transfer Cycles

Unexplained Infertility : 2015 (Abstract) Subtle Endometriosis and Unexplained Infertility

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa