Endometriosis and Pregnancy
I have endometriosis. Does this mean I can’t have children?
When it comes to Endometriosis, there are two main reasons that women seek my help. The first is extremely painful periods that affect their daily life. The second reason is they are having difficulty getting pregnant. Hardly a day passes without questions about endometriosis and how it will impact on the chance of falling pregnant, and no wonder, with endometriosis being a problem that affects up to 10 % of all women.
So what do we do?
Firstly, we need to understand what endometriosis is. Endometriosis is a tissue (called endometrium) found within the cavity of the uterus. In normal menstruation, hormonal changes occur, and this tissue sheds as part of your period. With endometriosis, that tissue abnormally implants in other areas of the pelvic cavity and can lead to the tissue within the pelvis swelling, becoming inflamed and bleeding from where the endometriosis has spread. With this, many women also experience extreme pain that can impact on their daily lives.
Over a prolonged time, scarring can occur leading to the ovaries, and tubes become stuck to the pelvis and ovarian cysts containing endometriosis can result.
While this sounds straightforward, many women suffer for years before a diagnosis is confirmed.
Endometriosis is diagnosed definitively by a laparoscopy, most commonly known as ‘keyhole’ surgery. While performing the diagnosis, I would also remove any skin within the pelvis that contains endometriosis.
Minimal endometriosis, with no blockage of the fallopian tubes, can have an impact on fertility by an assumed toxic effect. Keyhole surgery is a very useful procedure as a treatment of minimal endometriosis, and we often see a positive effect on pregnancy rates immediately after.
In moderate to severe cases, the scarring can interfere with the eggs release or journey through the fallopian tubes or the sperm from reaching the egg. Using dye studies as part of the diagnosis allows me to determine if the endometriosis has blocked the tubes.
Sometimes I see very severe endometriosis where the bowel and ovaries are all stuck down. In these cases, surgery to return the pelvic anatomy back to normal improves the chances of pregnancy.
For severe period pains, painful intercourse or infertility, laparoscopic surgery is an excellent option with a very good outcome.
When the fallopian tubes are blocked as a result of endometriosis, or after excision of endometriosis there is still no pregnancy, it can be discouraging. In these cases, I have found IVF technology offers excellent success rates for women becoming pregnant. For best results, I would recommend excising the endometriosis before undertaking an IVF cycle.
So, in summary, when the diagnosis is endometriosis, this does not automatically mean an end to your hope of having a family.
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