Managing Endometriosis-Related Infertility


Will Surgery Help?

Did you know that five to 10 percent of all women have endometriosis?  It’s a very common condition when tissue that is normally found inside the uterus grows outside the uterus.  This tissue may grow on your ovaries, on the outside of your uterus, on tubes, and even on the intestines or bladder.  It can cause pain and adhesions.  Many women have symptoms such as pain and heavy bleeding during their periods, while some women have none.

One of the symptoms is infertility.  From 30 to 50 percent of women with endometriosis are infertile, according to the American Society for Reproductive Medicine (ASRM).  A standard treatment for infertility used to be laparoscopic surgery, but times have changed, and so has treatment.

Endometriosis and Fertility

The only way to definitively diagnose endometriosis is laparoscopy.  In the twentieth century, the surgery routinely was used to view the uterus, fallopian tubes, ovaries and the pelvic cavity and to remove the endometrial tissue that was growing in the wrong places.  It was thought that surgically destroying the scar tissue would help a woman conceive.

ASRM has determined that treating endometriosis and infertility raises a number of complex clinical questions. Recent research has found that laparoscopy is not necessary in many cases.  Today, women who are infertile but have regular ovulatory cycles, patent fallopian tubes (their tubes have not been cut or plugged), normal ovarian reserve and a partner with a normal semen analysis are said to have unexplained infertility, though some of these women undoubtedly have endometriosis, according to RESOLVE, the National Infertility Association.  Infertility treatments and success rates are very similar for women with endometriosis and women with unexplained infertility.  And very few infertile women who undergo laparoscopy become pregnant because they had the surgery.

Fertility Treatment for Unexplained Infertility

About one in five couples will experience unexplained infertility after completing a full infertility workup, RESOLVE states.  It’s frustrating and distressing to be told there is no apparent cause for your infertility.  But don’t give up hope!  Some people will eventually become pregnant.  However, your chances of success are much higher with IVF.  Recently, a large randomized trial on couples with unexplained infertility called FASTT (The Fast Track and Standard Treatment (FASTT) Trial) found that couples who do not get pregnant after three rounds of IUI and Clomid should move to IVF instead of continuing IUI and Clomid.  They got pregnant faster with IVF and therefore spent less money on fertility treatment.

Often, subtle causes of infertility which can’t be detected in an infertility workup will become apparent during IVF treatment, such as poor egg quality.  Sometimes there is a problem with embryo development.  IVF enables genetic testing of the embryos with preimplantation genetic screening (PGS).  PGS tests for the correct number of chromosomes so that the only the healthiest embryo is transferred for implantation.  PGS can increase your chances of getting pregnant by as much as 23 percent, and also decreases your chance of having a miscarriage.  Each person needs her own personalized treatment plan for infertility.  Ask your reproductive endocrinologist if it’s time to move to IVF.



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