Endometriosis and Infertility

Verified by: Dr. Vandana Gawdi, Consultant Obstetrics & Gynecology, Apollo Hospitals Navi Mumbai
Dr. Nikita Lad Patel, Chief IVF, Apollo Hospitals Navi Mumbai

What is Endometriosis?

Endometriosis is a condition where tissues resembling the lining of the uterus (endometrium), start growing outside the uterus. These endometrial tissues are seen predominantly on the ovaries, followed by on the fallopian tubes, in and around the pelvic area, the sigmoid colon and the appendix. Abdominal pain is the most life-impacting symptom in most females whereas some females may be asymptomatic. Heavy bleeding during periods, painful intercourse and in advanced cases pain during defecation are common symptoms for which a person may visit a hospital. Long term changes and advanced stages of endometriosis may make a female prone to infertility.

How does Endometriosis cause infertility?

The abnormal endometrial tissues that deposit over the ovaries and fallopian tubes may cause adhesions and scar tissue, making it difficult for the implanted egg to reach the uterus through the fallopian tubes, may prevent the egg from being fertilised and released. This maybe because the fallopian tube/ tubes may get displaced from its orientation around the ovary where it usually lies. The ovulation cycle may get effected causing problems in conceiving and painful sexual intercourse. The ovarian reserve is often affected by long standing endometriosis and should be considered when seeking help for conception. Delay in seeking help may lead to more difficulties in conception.

What are the treatment options available for infertility due to Endometriosis?

• Medical management of endometriosis consists of balancing the hormones Oestrogen and Estradiol through medications. The aim of management will be to alleviate symptoms especially pain and to enhance or retain fertility.
• Surgical treatment involves Laparoscopy and/or Laparotomy to remove endometriosis lesions, adhesions, and scar tissue and to retain fertility. Surgery by laparoscopy is the preferred mode to remove cysts and adhesions that form by the lesions. Today robotic surgery can make the procedure less painful, has a quicker recovery time and gives a better outcome due to the precise nature of instruments.
• Placement of a hormone releasing Intra Uterine Device(IUD) through a simple hysteroscopy procedure that can be done even in an opd setting reduces symptoms of pain and excessive bleeding.
• Ovarian stimulation with Intrauterine Insemination (IUI): This procedure is an Assisted reproductive technology involving implantation of a sperm directly into the uterus through a long, flexible tube. Sperms may be acquired though a partner or donor. The procedure is painless with a short recovery period.
• In-vitro fertilization (IVF): IVF is an advanced form of Assisted reproductive technology. Here, medications help the female to produce more eggs. These eggs are retrieved and stored in a laboratory where they are provided with optimal conditions for growth. Once these eggs reach optimal size, they are impregnated with sperms to form embryos. The embryo is subsequently inserted in the uterus through a tube.

IVF at Apollo Hospitals Navi Mumbai: The Apollo Fertility centre provides Preimplantation Genetic Screening and Preimplantation Genetic Diagnosis to cater to individuals with recurrent abortions. The facility also analyses embryos for defects, donor egg cycles and critical conditions like Azoospermia. One can visit Apollo Fertility centre for IUD placement, IUI procedure and IVF.

An estimated 25 million females suffer from endometriosis in India with 25-50% of them being infertile. Infertility can have consequences on the physical, mental and social aspects of a woman. A multidisciplinary team approach consisting of a Gynaecologist-Obstetrician, Pelvic Physiotherapist, Pain specialists and Psychologists maybe helpful in the all-round management of endometriosis and infertility. Don’t let endometriosis ruin your dream of having a child!

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