Endometriosis is a condition which causes inflammation and scarring throughout the female pelvis. It still a poorly understood condition. It is progressive over time and can compromise fertility and also impact IVF outcomes. Endometriosis can be silent, or can present as painful periods, painful sex or infertility.
What are the forms of endometriosis?
Endometriosis has many forms, including ovarian endometriomas, nodules on the ligaments of the uterus and over bladder and bowel or peritoneal endometriosis which can alter the skin like covering tissue that is like a lining of the internal pelvis. This form of endometriosis cannot be seen on ultrasound. All forms of endometriosis can be associated with severe pelvic pain. The gold standard for both diagnosis and treatment of endometriosis is laparoscopy, a form of keyhole surgery in which fertility specialist Dr Raelia Lew is expertly trained.
Why do women develop endometriosis?
A tendency to develop endometriosis can run in families and is genetic. A risk factor is delaying your first pregnancy until later in life as pregnancy itself is protective against developing endometriosis. Paradoxically, having endometriosis can make it more difficult to conceive but having a baby can improve or even resolve symptoms of endometriosis for many women.
How is endometriosis diagnosed?
The most severe types of endometriosis can be seen on ultrasound but pelvic laparoscopy (key hole surgery as a day procedure where a high powered camera is used to examine the internal pelvis) is considered the gold standard for diagnosing endometriosis. Treatment to remove endometriosis can also be performed at the same time.
I think I may have endometriosis. What can I do to help me get pregnant?
Endometriosis can be treated surgically by laparoscopy which improves your chance of natural conception in the 3 months that follow.
IVF can be used to help a woman with endometriosis conceive. There is strong evidence that hormonally suppressing endometriosis by “turning off your menstrual cycle” for 3 months before IVF improves IVF pregnancy outcomes form women with endometriosis.
I’m not yet trying to have a baby but I have endometriosis. I’m worried about my future fertility….
If you think you may have endometriosis, I would advise you to make a time to speak to a gynaecologist, and ideally a specialist with expertise in fertility. In Australia, specialists that hold a CREI qualification are the best qualified to help you.
It may be of benefit to you to remain on the oral contraceptive pill long term until you are ready to try to conceive. It is important to be aware of other factors, like age and weight and smoking that can impact your fertility, as optimizing other factors will improve your overall chance of having the family you one day dream of.