More than 11% of women in the US are affected by endometriosis. The condition causes the endometrium, or tissue that usually grows inside the uterus, to grow outside. Endometriosis most commonly affects the ovaries, fallopian tubes, and tissue lining the pelvis. During a normal menstrual cycle, healthy endometrial tissue sheds, but for women with endometriosis, the tissue builds up over time, causing scarring, inflammation, and cysts. Women with endometriosis often report painful periods, pain with intercourse, excessive bleeding, and infertility.
Consult a RE
If a woman with endometriosis has been unable to conceive successfully, a consultation with a reproductive endocrinologist (RE) is a good first step. The fertility doctor will perform a physical exam and collect a detailed medical history. The doctor may ask questions about the menstrual cycle, endometriosis symptoms, and pain level. An ultrasound will likely be performed to check the extent of the endometriosis and see what areas outside the uterus are affected. Based on the information collected, the RE will determine whether the patient’s endometriosis is stage 1, 2, 3 or 4 and recommend appropriate fertility treatment, if necessary.
Should a woman with endometriosis require ART, intrauterine insemination (IUI) is often the first procedure recommended. During IUI, the partner or donor’s sperm is collected, washed, and concentrated, then placed directly into the uterus near the time of ovulation. This approach works great for women who may have blockages in the fallopian tubes due to endometrial tissue growth or scarring in the area. Patients can also opt to add in ovarian stimulation, which increases the number of eggs released in a single cycle, increasing the chances of success.
Moving forward with IVF
If IUI is not successful after a few attempts, in vitro fertilization (IVF) is typically the next option considered. During IVF, a woman is given medication to stimulate the ovaries to produce eggs. Once extracted, the eggs are combined with sperm in a lab to make an embryo. The embryo is then transferred directly into the uterus. Again, this approach circumvents any inflammation, scarring, or blockages in the fallopian tubes. Women with stage 3 or 4 endometriosis are usually good candidates for IVF.
A baby is possible
With proper treatment and management of the disease, endometriosis can be well controlled, lowering the chance of side effects, including infertility. Should patients have difficulty conceiving, a fertility specialist may recommend IUI or IVF depending on the extent of damage present and the stage of the disease. With a bit of help from science, a baby is possible.