Endometriosis and Infertility – Can Surgery Help?
Millions of women in the U.S. have endometriosis, a condition when tissue that lines the uterus grows outside it. The tissue may grow on the fallopian tubes, which carry eggs to the uterus, or your ovaries, sometimes even on your bladder or intestines. Endometriosis can be painful, because this tissue which is in the wrong places tries to bleed and shed each month as if it were in the uterus, irritating the organs where it grows.
If you have pain from endometriosis and are not trying to conceive, your doctor may prescribe birth control pills or other hormones. These medications will lessen your period or stop it from happening, putting an end to the pain. If you are trying to get pregnant, hormone medications are not the answer, because as well as stopping your period, they also stop ovulation.
When You’re Trying to Conceive
Women don’t always have pain with endometriosis. In fact, some women only learn that they have the condition when they have problems getting pregnant. Infertility can be one of the side effects of endometriosis. Up to 30 percent to 50 percent of women with endometriosis experience infertility, according to the American Society for Reproductive Medicine (ASRM). Endometriosis can make getting pregnant more difficult by scarring the fallopian tubes, causing inflammation of the pelvic structures, creating scar tissue called adhesions, and changing the hormonal environment of the eggs.
The only way to determine if you have endometriosis is a procedure called laparoscopy. Laparoscopy is used to look at the outside of the uterus, fallopian tubes, ovaries, and the internal pelvic area. If any abnormalities are discovered they can be removed during the same procedure. Laparoscopy is performed under general anesthesia and involves just a few small incisions, to insert the lighted scope, a probe, and any other instruments if they are needed.
Should You Have Laparoscopy?
If you’re having trouble trying to conceive, it’s most important to consult a reproductive endocrinologist, a fertility specialist who can evaluate you thoroughly and develop the best course of treatment for you. As the ASRM observes, “Treatment of endometriosis in the setting of infertility raises a number of complex clinical questions that do not have simple answers.” Some studies have found improved fertility rates after laparoscopy, especially among women with mild endometriosis. However, the effect of removing the abnormalities only appears to last for about a year, and then the tissue grows back. It is not recommended to have laparoscopy more than once if you are trying to get pregnant, because a second procedure can cause more scar tissue and reduce your ovarian reserve (the number and quality of your eggs).
In the 20th century, laparoscopy was standard procedure for all women with infertility to determine if they had endometriosis. Today, it is essential that both the female and the male partner have their fertility evaluated so you can pursue the treatment plan that is more likely to work for you. Especially if you are over 30 or have severe endometriosis, a reproductive endocrinologist can help you focus on your goal of getting pregnant, without losing time by pursuing procedures that are less effective. He or she can help you determine if you may be more successful by going straight to IVF, or if laparoscopy or other procedures will be needed.