Endometriosis is a condition characterized by the growth of the uterine lining-like tissues outside the uterine cavity.

The condition affects up to 10% of women at their reproductive ages between the ages of 15 and 44 and can get worse without treatment.

As the condition is prevalent during the reproductive years, can Endometriosis affect fertility?

This comprehensive article will elaborate on the important question of does Endometriosis cause infertility.

Further, it uncovers the symptoms, causes, diagnosis, and treatment to improve the chances of fertility in women with Endometriosis.

Does Endometriosis cause infertility

The straightforward answer to this question is yes. Endometriosis does cause infertility in many women.

The statistics of the Endometriosis infertility rate convey that the prevalence of infertility in women with Endometriosis is a serious concern affecting millions of women worldwide.

According to the American Society for Reproductive Medicine, the prevalence of infertility in women with Endometriosis is as high as 30% to 50%.

But does all women who have Endometriosis are infertile? No.

The symptoms may not affect all women with Endometriosis. But it can make conceiving difficult for some women who have it.

Warning:
Pregnancy with Endometriosis is associated with high risks of miscarriage, premature birth, and a higher cesarean section rate. Consult a healthcare practitioner and seek prompt medical attention.

How Endometriosis causes infertility

Endometriosis
Endometriosis written on a paper

Endometriosis is a multifactorial condition (dependent on a number of factors) that exhibits direct or indirect effects on the female reproductive system.

Endometriosis can affect fertility and lead to infertility in the following ways:

Distorted anatomy and pelvic adhesions

Anatomical distortion of the pelvic region and pelvic adhesions are the potential causes that can affect conception in women with Endometriosis.

The major factors involved are inflammation, fibrosis, and adhesions of the pelvic structures.

Further, anatomical distortion and mechanical factors can lead to the following impairments, which elevate the chances of infertility:

  • Release of an impaired egg from the ovary
  • Inhibited transfer of the egg
  • Blockage of sperm to the fallopian tubes

The altered ovarian reserve

A female ovary is the most common site for the development of Endometriosis. Thus, it can affect the ovarian reserve or environment, leading to infertility.

It happens when the Endometriosis grows inside the female ovary and forms a cyst called Endometrioma.

There is morphological and histological evidence that Endometrioma can have a detrimental effect on the ovarian reserve.

Unlike other benign cysts, the fluid inside Endometriosis cysts can induce oxidative stress and can potentially damage healthy cells.

The toxins released by the cysts can lead to reduced maturation of the follicles and, with damage to the surrounding tissues, ultimately cause follicular damage.

Changes in embryo quality and effect of egg

One recent research studied the effects of Endometriosis on the quality of developing embryos.

It found that the quality of embryos in women with Endometriosis is poorer.

However, the possible effect of Endometriosis on the quality of an egg is still under research.

Further, from the egg donation perspective, reduced pregnancy and implantation rates are reported when the egg is received from a donor with Endometriosis.

This can only lead to the poorer quality of the embryo. However, no difference was observed in the donated eggs either in the presence or absence of Endometriosis.

Also Read: To gain a complete understanding of the effect of Endometriosis on pregnancy, read “The Complex Relationship Between Endometriosis and Pregnancy.”

Changes in immune system functioning

An altered immune system and inflammatory profile in women characterized by Endometriosis also influence the composition of follicular fluid.

The consecutive changes in the immune system functioning in women with Endometriosis are one of the causes of infertility.

Scarred fallopian tubes

The anatomical distortions in the fallopian tubes affect the process of gamete transfer.

The Endometriotic pro-inflammatory peritoneal fluid microenvironment may also affect the following functions:

  • Sperm quality
  • Reduce mobility 
  • Cause an abnormal acrosome reaction (the reaction that occurs when sperm reaches the egg and breaks the surrounding coat)
  • Impair sperm-egg interaction

Impaired ovulation

Ovulation can also get impaired by high levels of Prolactin in women with Endometriosis.

High Prolactin levels can interfere with hormonal function and cause the lack of release of an egg.

Consequently, a lack of eggs can make conception difficult and increase the risks of fertility issues.

Fact:
Prolactin is a biomarker differentiating between mild Endometriosis stages I/II and moderate to severe stages III/IV.

What stages of Endometriosis cause infertility

The stages of Endometriosis can impact infertility differently.

While the severity of Endometriosis is often classified into four stages (I, II, III, IV), the severity of symptoms may not always correlate with the stage.

However, the most severe stage, i.e., stage IV is a potential threat to fertility, as it causes considerable damage to the ovaries, scarring, and blocked fallopian tubes.

Despite the challenges experienced during the severe stage of Endometriosis, 60% to 70% of women can get pregnant effectively.

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Diagnosis of Endometriosis and infertility

ovulation tests
Ultrasound and ovulation tests

The population of women with Endometriosis-associated infertility can have a variety of clinical presentations.

It makes it difficult to establish a precise Endometriosis diagnosis for infertility associated with Endometriosis.

However, women can consult a healthcare practitioner and seek diagnostic tests for the early detection of infertility.

A doctor can conduct the following tests in women with Endometriosis:

  • Pelvic examination test
  • Ultrasound
  • Magnetic Resonance Imaging (MRI)
  • Laparoscopy

Endometriosis infertility treatment

To overcome the severe consequences, a multistep Endometriosis treatment technique is adopted in women with Endometriosis.

As per the Clinical and Experimental Reproductive Medicine, surgical therapy of Endometriosis can cause ovary injury and significantly deteriorate the ovarian reserve.

Therefore, it is best treated depending on the stages of Endometriosis.

In mild to moderate Endometriosis, Intrauterine Insemination (IUI) with ovarian stimulation can significantly increase the likelihood of pregnancy.

In women with severe Endometriosis, the prioritization of the treatments includes Assisted Reproductive Technology (ART).

Medical intervention and timely action in seeking medical help can significantly reduce the risk of infertility and help women conceive and embrace motherhood.

Conclusion

Endometriosis is a multifactorial condition and can directly or indirectly affect the female reproductive tract, causing infertility.

It can distort the anatomy of the pelvis and alter the ovarian reserve, which can impact fertility.

Further, it can lead to changes in embryo quality, immune system functioning, scarred fallopian tubes, and impaired ovulation that may lead to infertility.

The stages of Endometriosis can also impact fertility differently. The severe stage causes considerable damage to the ovaries, making it difficult to get pregnant.

Women can consult a healthcare practitioner to prevent such consequences and conduct pelvic tests, ultrasound, MRI, and laparoscopy to detect Endometriosis.

A healthcare practitioner can take multistep treatment depending on the stage of the Endometriosis to treat infertility.

Frequently Asked Questions

How does Endometriosis cause infertility?

Endometriosis can distort the anatomy of the pelvis and alter the ovarian reserve, which can impact fertility. Further, it can lead to changes in embryo quality, immune system functioning, scarred fallopian tubes, and impaired ovulation that may lead to infertility.

Why does Endometriosis cause infertility?

Endometriosis causes infertility as it can distort the pelvic anatomy, alter the ovarian reserve, and impact fertility. Further, it can alter embryo quality, changes in immune system functioning, scarred fallopian tubes, and impaired ovulation that may lead to infertility.

How can I cure my Endometriosis and infertility?

Consult a healthcare practitioner to treat Endometriosis and infertility. Based on the severity of the condition, a multistep treatment is taken for Endometriosis. In the case of mild Endometriosis, Intrauterine Insemination is done. However, in the severe stages, surgical treatment and Assisted Reproductive Technology are done.

What stages of Endometriosis cause infertility?

While the severity of Endometriosis is often classified into four stages (I, II, III, IV), the impact of fertility may not always correlate with the stage. However, the most severe stage, which causes considerable damage to the ovaries, scarring, and blocked fallopian tubes, is the most difficult to get pregnant.

Citations:
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