Endometriosis affects about 40% of infertile women. It is estimated that 1 din 10 women of reproductive age has endometriosis lesions. Scientists around the world are currently studying this mysterious disease and its mechanisms, wanting to understand it better and discover new methods of treatment.
What is endometriosis and what are its most common symptoms?
Endometriosis represents the presence of endometrium similar tissue in other regions of the body. The inflammation of these lesions can cause cysts, nodules or endometriosis adhesions.
The most common symptoms of endometriosis are: menstrual pain, pelvic pain, irregular bleeding, pain during intercourse, pain on urinating, pain in defecating, heavy period etc.
Often times, endometriosis can cause infertility. Because they can’t conceive spontaneously, many endometriosis patients head to ART specialists. Endometriosis has strong hormonal and inflammatory components; therefore the desired protocol during the Artificial Reproductive Techniques must be a little bit different than that applied to women undergoing IVF, but who do not have endometriosis.
Study: Effects of endometriosis on assisted reproductive technology
In a recent complex research, scientists analysed in great detail the mechanisms by which endometriosis affects fertility, and also ART - assisted human reproduction techniques.
In addition, they also determined how efficient could be these techniques for the endometriosis associated infertility.
The present study was conducted by Paul Pirtea, M.D, Dominique de Ziegler, M.D and Jean Marc Ayoubi, M.D, Ph.D. The results of the research were published in the medical journal “Fertility and Sterility” in October 2020.
The mechanisms by which endometriosis affect fertility are not fully known. Infertility in endometriosis is relative
Specialists are analysing how endometriosis affects fertility. There are still a lot of questions along the way and studying them could help in finding some future viable solutions.
Besides, it’s important to know endometriosis associated infertility is relative. There are cases of patients with severe endometriosis that conceived spontaneously - yet, this is not the "general rule".
The above research looks at all infertility factors, based on endometriosis location
The pelvic cavity, ovaries and uterus are the main areas where endometriosis lesions are most common and affect fertility. The doctors involved in the study analysed all these based on their own research, but also on the results of other previous studies.
Endometriosis in the pelvic cavity
The inflammation processes associated with endometriosis from the pelvic cavity are causing a toxic environment. Doctors believe this precisely toxic pelvic environment affects the chances of natural conception.
The toxic pelvic environment and the inflammation affect the sperm and oocyte quality. These alterations could also modify the fertilisation process result.
Other previous studies showed that even a short exposure to these toxic effects could modify the embryos and their capability of develop.
Basically, this would mean a lower ART success rate.
Endometriosis and the ovaries
Cysts and endometriomas could modify the answer to ovarian stimulation. Previous studies showed endometriosis patients tend to have less oocytes and higher cancellation rates for insufficient response to OS – compared to aged matched endometriosis free patients.
Endometriosis in the uterus
Because of the inflammatory processes and hormonal disorders, endometriosis can also affect the uterus.
These negative effects of endometriosis can be corrected
Specialists have proved these negative implications can be corrected by different methods. One of these is ovarian suppression using the oral contraceptive pill or a gonadotropin-releasing hormone agonist.
Several previous research showed the ART success rate in endometriosis patients is similar to that of women without endometriosis
The good news for endometriosis patients is that the ART success rate is similar to that of endometriosis free women. Yet, in this case, doctors should follow certain techniques and practices.
The conclusion of the research: ART (artificial reproductive techniques) is the recommended treatment for endometriosis-associated infertility
The conclusions of this complex research show that the artificial reproductive techniques are preferred when it comes with infertility in endometriosis.
Endometriosis alters the chances of natural conception, especially because of the toxic conditions of the uterine cavity. Yet, this could be bypassed by reverting to ART.
On the other hand, treatments based on natural conception (ovarian stimulation, for example) are not recommended in endometriosis. The same happens with fresh embryo transfers.
“Endometriosis is a complex disease, with various implications. Endometriosis patients who want to conceive should have as a first option IVF (in vitro fertilization). We don’t recommend inseminations and small ovarian stimulations. If the IVF procedure is done right, specific to this condition, their chances of conceiving are similar to the chances of conceiving of women undergoing IVF but who do not have endometriosis.
On the other hand, the solution for endometriosis patients who have symptoms incompatible with a good quality of life would be surgery in specialized centres, especially after drug treatments have been exhausted. ” told us dr. Paul Pirtea, the doctor who conducted the mentioned study.
Here you can read more about this research and all the mentioned studies.