Even with the advancements of modern medicine, carrying a pregnancy to term successfully can be a prolonged and strenuous venture. This sentiment especially rings true for those attempting to conceive with endometriosis, a condition which is a leading cause of infertility in women. According to an estimate, endometriosis affects 0.5% to 5% of fertile women and around 25% to 40% of infertile women.
There are several factors that can lower the conception rate for endometriosis patients, each of which can influence the treatment plans for individuals. Hence, there are no universal strategies of action to improve fecundity within those with endometriosis. Therefore, treatments must be tailored on a case-by-case basis.
As endometriosis is an estrogen-receptive condition, the heightened amount of estrogen released during pregnancy can cause spikes in endometrial symptoms. The first trimester can be a particularly susceptible window for endometriosis patients, as a chronically heightened immune response can result in early-term miscarriages. Additionally, those with endometriosis are at a risk for ectopic pregnancies due to altered anatomy and tubal involvement, which, by nature, are not viable. There is also an increased rate of symptoms during pregnancy, such as higher chances for premature births or lowered birth weight. Endometriosis in situ is also a reason for multiple failed IVFs.
Furthermore, the hormonal treatments that lower estrogen levels in order to avoid endometrial tissue growth directly lead to a lower follicular response and rate of conception. Patients must stop all hormone blockers for a sustained period of time before successfully conceiving.
Sometimes, due to endometriosis patient’s ovarian reserve may be very low and surgery may further lower the ovarian reserve. In such cases where endometriomas are not very big, oocyte or embryo cryopreservation is an option but transfer should be done after endometriosis excision.
Treatments to improve fertility rates can differ depending on the severity, symptoms and locations of endomertiotic lesions experienced by each patient.
Laparoscopic excision of endometriotic lesions restores the pelvic anatomy and enhances the chances of spontaneous and assisted conception. Patients with severe endometriosis generally require a long-term, multidisciplinary approach to help them conceive successfully.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941592/
https://pubmed.ncbi.nlm.nih.gov/18443335/
https://pubmed.ncbi.nlm.nih.gov/23182559/
https://pubmed.ncbi.nlm.nih.gov/22031261/
https://www.healthline.com/health/endometriosis/endometriosis-and-miscarriage
https://www.endofound.org/can-endometriosis-increase-your-risk-for-miscarriage