Alexandra, one of our followers, asked us: “I had some struggle getting pregnant. I went to the fertility clinic, and ran some tests. After I got the results, the doctor told me that I have Endometriosis. I felt like it’s the end of the world! Will I ever be able to get pregnant?’’
Dear Alexandra, first, let us tell you, that of course, it is not the end of the world! Nowadays, there are many ways to have kids of your own.
Second, let’s try to understand better and deeper what Endometriosis is.
Endometriosis is a condition in which endometrial tissue that lines the uterus begins to spread outside of the uterus and implant in places like the fallopian tube, ovaries, and other organs in the pelvic region. When it grows normally inside the uterus, endometrial tissue sheds during every menstrual cycle, creating a monthly period. But endometrial tissue also sheds when implanted or attached to organs outside of the uterus, and this shedding can cause inflammation, cysts, and scar tissue throughout the pelvic region. It should be taken into account that there are 4 stages of Endometriosis and discussing and understanding each stage will make clear for anyone who has been diagnosed with endometriosis whether they will get pregnant or not.
What do the Endometriosis Stages Mean?
The best way to diagnose endometriosis is laparoscopy. Based on what the doctor sees during the laparoscopy, endometriosis is categorized into 4 different stages.
Experts use stages to classify endometriosis by severity, but the stage doesn’t always correspond to a woman’s pain and discomfort levels.
It is interesting to know that most patients are found to have stage 1 and stage 2 endometriosis. Let’s have a close look at all stages of endometriosis:
In stage 1, the endometriosis is considered ‘’minimal”. The implants are small, few in number, and shallow. Superficial lesions are present, lesions do not penetrate deeply and are mostly located within the lining of the abdominal cavity (peritoneum). Although keep in mind that these stages don’t correspond to pain and discomfort levels. Just because a woman might have Stage 1 endometriosis, this doesn’t mean that the pain is minimal or that the effect on her life has been minimal.
In stage 2, the endometriosis is considered ‘’mild”. In this case, More lesions and ovarian endometriomas are presented. Doctors might find more implants, and they are deeper than the superficial implants found in Stage 1 endometriosis.
Stage 3 is ‘’moderate” endometriosis. There is a range of deep infiltrating endometriosis lesions, endometriomas, and adhesions. There are endometrial cysts from when the tissue attaches to an ovary and begins to shed blood and tissue. The blood collects and turns brown, which is why these growths are also known as ‘’chocolate cysts.” Doctors may also find thin bands of tissue, called filmy adhesions, that bind organs together. These adhesions are the scar tissue that form when the body tries to heal from the inflammation caused by endometriosis. They can make organs stick together when they shouldn’t and are thought to be the cause of sharp, stabbing pains, as well as nausea, in women with endometriosis.
Stage 4 is the ‘’severe” stage of endometriosis. In addition to many deep endometriosis implants, there are large cysts on at least one ovary and many dense adhesions through the pelvic region. Lesions penetrate deeply, significant scar tissue or adhesions and large ovarian cysts are presented. It should be taken into account that endometriosis can be found in other parts of the body including the bowel, bladder, and rarely in the lungs.
Where can Endometriosis Occur?
The most common sites of endometriosis include:
- The ovaries;
- The fallopian tubes;
- Ligaments that support the uterus;
- The posterior cul-de-sac, i.e., the space between the uterus and rectum;
- The anterior cul-de-sac, i.e., the space between the uterus and bladder;
- The outer surface of the uterus;
- The lining of the pelvic cavity;
Occasionally, endometrial tissue is found in other places, such as:
- The intestines;
- The rectum;
- The bladder;
- The vagina;
- The cervix;
- The vulva;
- Abdominal surgery scars;
Endometriosis and Infertility
Endometriosis is considered to be one of the three major causes of female infertility. Endometriosis can affect fertility by making it difficult for sperm to reach the eggs, and for the eggs to reach the uterus. For instance, endometrial deposits on the ovaries or fallopian tubes can prevent the passage of the eggs to the uterus. The tissue on the fallopian tubes, vagina, or cervix can prevent the sperm from reaching the eggs.
According to the American Society for Reproductive Medicine, endometriosis can be found in 24 to 50 percent of women who experience infertility.
In mild to moderate cases, infertility may be temporary. In these cases, surgery to remove adhesions, cysts and scar tissue can restore fertility.
In other cases — a very small percentage — women may remain infertile.
How endometriosis affects fertility is not understood clearly. It is thought that scar tissue from endometriosis can impair the release of the egg from the ovary and subsequent pickup by the fallopian tube. Other mechanisms thought to affect fertility include changes in the pelvic environment that results in impaired implantation of the fertilized egg.
So, is it Possible to Get Pregnant with Endometriosis?
Well, as it was already mentioned above, endometriosis really affects fertility, but on the other hand, to be diagnosed with endometriosis does not directly mean that you can not get pregnant. It depends on many factors and especially on which stage your endometriosis is. It is strongly recommended that after diagnosed endometriosis you see a fertility specialist. A fertility specialist may conduct blood tests, such as an anti-mullerian hormone (AMH) test. This test reflects your remaining egg supply. A fertility specialist can work with your doctor to determine the severity of your endometriosis symptoms, to see at which stage your endometriosis is, and contributing factors to your fertility issues.
Examples of Treatments for Endometriosis-related Fertility Issues
So, examples of treatment in the case you are diagnosed with endometriosis include:
- Freezing your eggs. Endometriosis can affect your ovarian reserve, so some doctors may recommend preserving your eggs now in case you wish to become pregnant later. This option can be costly and isn’t usually covered by insurance.
- Superovulation and intrauterine insemination (SO-IUI): This is an option for those who have normal fallopian tubes, mild endometriosis (stage 2), and whose partner has sperm with no fertility issues.
- Have you heard about the medication Clomiphene? If not, you should know that a doctor can prescribe this fertility medication, so that it helps to produce two to three mature eggs. A doctor may also prescribe progestin injections.
- In Vitro Fertilization (IVF): This treatment involves extracting an egg from you and sperm from your partner. The egg is then fertilized outside the body and implanted into the uterus.
The success rate of IVF for those with endometriosis is about half of the success rate of those with other reasons for fertility. But many people with endometriosis have successfully gotten pregnant thanks to IVF treatment.
IVF is often recommended for people with moderate to severe endometriosis (stage 3 and stage 4) or for those whose bodies haven’t responded to other treatments.
So, as you already know more about Endometriosis and also the possible ways to get pregnant, the only step you should fulfill is to call us!
Be Parent is looking forward to your first appointment!