Some women with endometriosis may become pregnant without any difficulty, however
there is an association between endometriosis and infertility. In advanced forms
of endometriosis where there is significant scarring and anatomical distortion in
the pelvis release and transport of egg from the ovaries through the fallopian tubes
may be compromised. Similarly sperm and embryo transport in the fallopian tubes may
also be affected in these situations. Altogether, these factors may reduce fertility.
In early forms of endometriosis the association between endometriosis and infertility
is more controversial. Nevertheless, this form of endometriosis is more common in
women with fertility difficulties. There is also some evidence that surgical elimination
of early endometriosis increases fertility rates, suggesting that even early forms
of endometriosis may reduce fertility.
What are the treatment options for fertility in women with endometriosis?
Some women may conceive without any treatment. When there is a difficulty in conceiving
there is no benefit of using hormonal treatment to improve fertility. Surgical treatment,
usually in the form of laparoscopic surgery is known to increase chances of pregnancy.
Elimination of endometriotic spots, nodules and scarring and restoration of pelvic
anatomy at surgery tends to increase pregnancy rates.
In some women with endometriosis, surgery on its own may not be enough to achieve
a pregnancy and additional treatment may be needed. If the pelvic anatomy is relatively
normal and the fallopian tubes are open artificial insemination (intrauterine insemination,
IUI) may be beneficial.
This is usually combined with the use of fertility drugs to increase the number of
eggs released during the treatment cycle to improve success rates. However when the
pelvic anatomy is severely damaged, particularly when the Fallopian tubes are blocked
or when the other treatment options fail, test tube baby treatment (IVF) may become
necessary. In women where the fallopian tubes are severely damaged the option of
removing the tubes (salpingectomy) prior to IVF treatment may be discussed.
