The link between endometriosis and infertility is sometimes difficult to explain. When the disease is so bad that there is much scarring around the tubes, or there are ovarian cysts, it is not surprising that this might interfere with normal fertility.

Whether or not so-called “mild” endometriosis affects fertility has remained controversial. At Welling Clinic, we strongly believe that endometriosis, even when mild, can negatively affect fertility. Even more importantly, endometriosis affects fertility adversely in many different ways, though its effects on normal tubal function appear to be the most important.

It is less clear how a few small spots of endometriosis might have a detrimental effect on attempts at pregnancy. Nevertheless, studies have found that endometriosis is more common in women who have difficulty conceiving, supporting the link.

Endometriosis is an estrogen dominant condition. When there are too much estrogen in the system, it causes hormonal imbalance. Proper hormonal balance is essential for healthy fertility.

Endometriosis also creates a situation of “congestion” where there are excess tissues growing in the uterus (as well as other areas of the body) which makes it harder for an embryo to attach and grow healthy.

Every month the excess tissues bleed which cause inflammation to occur and scar tissue to begin adhering to uterus, fallopian tubes, the ovaries, and other organs. This causes some serious “congestion”. If endometrial cells attach to the ovaries or fallopian tubes this may alter normal ovulatory function or cause the fallopian tubes to become blocked.

As if that was not enough some researchers suggest that the woman’s body may form antibodies against the misplaced endometrial tissue. The same antibodies may attack the uterine lining and cause miscarriages (up to three times the normal rate).

Investigations attempting to explain why patients with endometriosis are often infertile suggest that:

• Their fallopian tubes may function abnormally, due to adhesion or scarring (so-called tubal infertility)
• Ovarian function may be adversely affected, possibly resulting in sub-par egg quality
• Endometriosis may release toxic substances which may harm embryos and/or their implantation capacity
• Patients with endometriosis may be at a higher risk for miscarriages, lowering their live birth chances

Finally, there may be an immunological factor involved in endometriosis. There is possibility of association of autoimmunity and endometriosis, suggesting that endometriosis, indeed, may be an autoimmune disease. It is now widely accepted that the immune system, indeed, plays an important role in endometriosis-associated infertility. 

How endometriosis affects IVF success rates?

Endometriosis appears to affect IVF adversely, from reducing the number of eggs at the time of retrieval to poorer egg quality, and lower implantation and pregnancy rates. However, most endometriosis patients will still be able to conceive with IVF.

Can “unexplained infertility” be endometriosis?

Endometriosis often initially presents as “unexplained infertility,” a diagnosis WELLING CLINIC does not believe in. Many studies in the literature point to similar patient profiles in women with endometriosis and unexplained infertility. They also present with similar immune profiles.

In most cases of so-called “unexplained infertility,” we, however, can pinpoint a real cause of infertility by performing appropriate diagnostic tests, even though correct diagnosis of endometriosis can be difficult.

Whats the treatment for Endometriosis?

As fertility specialists we, however, are always concerned about the surgical treatment of endometriosis: especially if surgery involves the ovaries, we often see that such surgery ends up removing the last vestiges of functioning ovarian tissue, and puts the patient into menopause. CHR, therefore, rarely recommends surgery before patients have completed their families.

Endometriosis infertility treatment requires special expertise. Such need for special expertise is not limited to surgery for endometriosis. Fertility treatments often involve increases in estrogen levels. Estrogen, however, can “feed” endometriosis, and make it worse.

Finding the right balance between advantages and risks of different infertility treatments, therefore, is always of utmost importance in the treatment of endometriosis.