Endometriosis and Trying to Conceive
Ask any of the five and a half million women and girls in the USA and Canada today that suffer from Endometriosis to describe it and they will all tell you that this chronic disease is extremely agonizing and somewhat debilitating. However, there are many cases where women who are trying to conceive with endometriosis have been quite successful at becoming pregnant.
What do you need to know about Endometriosis?
The endometrium is the name given to the lining of your uterus and can usually be found only inside the uterus. However, for a person with endometriosis, tissues from the lining of the uterus travels through the fallopian tubes and begins to grow outside the uterus on other organs, such as the ovaries, pelvis, bladder, and abdomen. Other sites for these endometrial growths may include the bowel, the outer surface of the uterus, the vagina,the area between the vagina and rectum, cervix, vulva, and in abdominal surgical scars. Less commonly, they can also be found in the lung, arm, thigh, and other parts of a woman’s body.
During a woman’s monthly period, the uterine endometrial lining is discharged through their menstrual flow. For a woman that has Endometriosis, all of the out-of-place endometrial tissue growths in the viscera will respond to the menstrual cycle in the same way that the tissue of the uterine lining does – by building up each month, then breaking down and shedding itself. Unlike the uterine lining that is discharged in the vagina, the tissues shed from endometrial growths has no way of leaving the body. This creates internal bleeding and breakdown of the blood and tissue from the lesions. It also causes inflammation, infertility, pain, adhesions, scar tissue formation, and bowel problems.
How will you know if you have Endometriosis?
According to the U.S. Department of Health and Human Services Office on Women’s Health, a few of the most common symptoms of Endometriosis are as follows:
- Extremely painful menstrual cramps that can continue to worsen over time
- Chronic lower back and pelvis pain
- Pain during or after sex
- Intestinal pains
- Painful bowel movements
- Painful urination throughout you menstrual period
- Spotting or bleeding between menstrual periods
- For the duration of the menstrual period you may experience diarrhea, constipation, bloating, or nausea
Recent research has exposed a link between endometriosis and other health problems in women, such as:
- Allergies, asthma, and chemical sensitivities
- Autoimmune diseases, where your body’s own immune system that is supposed to fight off illness, instead attacks itself. Examples of autoimmune diseases are hypothyroidism, multiple sclerosis, and lupus.
- Chronic Fatigue Syndrome (CFS) and fibromyalgia
- Constant infections, such as mononucleosis
- Mitral valve prolapse, wherein one of the heart’s valves does not close as tightly as normal
- Recurrent yeast infections
- Certain cancers, like ovarian, breast, endocrine, kidney, thyroid, brain, and colon cancers, and melanoma and non-Hodgkin’s lymphoma
Although Endometriosis can be suspected based on the above symptoms, there are plenty of other diseases that share the same symptoms so a proper diagnosis needs to be made. The Endometriosis Institute explains that the only way to do this is through a laparoscopy, which is a minor surgical procedure performed under anesthesia. It usually shows the location, size, and magnitude of the endometrial growths.
How is Endometriosis related to infertility?
The issue relating infertility to endometriosis has always been controversial. Studies have shown that 25% to 50% of infertile women have endometriosis while 30% to 50% of women with endometriosis are infertile. Endometriosis is believed to be the leading cause of infertility, affecting women between the ages of 25 and 40. Studies have also shown that endometriosis sufferers conceive at rates that are lower than women without endometriosis, but miscarriages are more common in endometriosis patients than in those women without. Those who suffer from endometriosis are also prone to progesterone deficiency that can make implantation weak, resulting in early miscarriages.
There are many options available to help women with this condition. One of the more common treatment options is surgery where the excess of the tissue is removed from other organs of the viscera. Such treatments can be used along with excisional therapy and medical suppressive therapy, especially if there is any suspected residual disease. A woman can choose to have medical therapy or surgery, or even a combination of both. Medical therapy often involves relieving pain as well as hormonal treatments. Although there have been quite a few randomized clinical trials (RCTs) conducted, a review of 13 RCTs that involved almost 800 infertile women with endometriosis found that there was no evidence that ovulation suppression was any better than taking a placebo in women who wished to conceive. Surgical methods have been linked with improved live birth rates. However, the combination of the two treatments has proven to be most beneficial when paired with in vitro fertilization.
In cases of moderate to severe endometriosis, surgical excision of all of the tissues in addition to reconstruction and restoration of the reproductive organs has been shown to achieve pregnancy rates that are higher than for untreated women. A few studies suggest that post-surgical medical suppression with gonadatropin agonists, such as Lupron, Synarel, and Zoladex, can help improve pregnancy rates in women with endometriosis. These therapies can also help to relieve endometriosis pain.
Mild endometriosis patients should continue to try to conceive. Talk to your doctor about whether using an ovulation induction medicine, like clomiphene citrate (Clomid or Serophene) could help. In addition, there is a technique referred to as ‘washed intrauterine insemination’ that has been proven to improve pregnancy rates in women with endometriosis if given sufficient time without other factors, such as cervical and male factors, and irregular ovulation.