Endometriosis and infertility – what’s the link?

Endometriosis is a condition in women that makes it more difficult for them to get pregnant. In general, the worse the endometriosis, the greater the difficulty conceiving. However, if you are diagnosed with severe endometriosis, you are not necessarily infertile. Getting pregnant may take longer, a lot longer in some cases, and you may need infertility treatment and/or treatment for your endometriosis before you can have a baby.

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Endometriosis affects about 10 % of women of reproductive age, although some estimates but its incidence as low as 2 %, others as high as over 20 %. It is characterised by the tissue that usually lines the uterus also growing in other parts of the abdomen. This can affect the outside of the uterus, the ovaries and fallopian tubes, the intestines, kidneys and bladder. The most common symptom is pain caused by inflammation and adhesions as the endometrial tissue expands every month in response to oestrogen, a hormone produced during the normal menstrual cycle.

Inside the uterus, oestrogen stimulates the production of a thick, blood-rich lining that is then ready to receive a fertilised egg should the woman conceive that month. Unfortunately, the same tissue that occurs outside the uterus behaves in the same way, causing an increase in pain during the middle of the menstrual cycle.

Infertility is most often linked to endometriosis that causes adhesions to form near to, or around the ovaries. These pieces of extra tissue can prevent the ovaries producing or releasing eggs, and they can also block the way for the egg to progress down the fallopian tube. In some women, adhesions caused by endometriosis actually block the fallopian tubes.

Infertility treatments can help if you have endometriosis that impacts severely on the ovaries and fallopian tubes. Techniques such as gamete intra-fallopian transfer (GIFT) can avoid the problems around the ovary by collecting eggs, mixing them with your partner's sperm, and then putting the mixture directly into the fallopian tube, where the eggs have a chance to be fertilised and then implant in the uterus normally. Women with endometriosis can also benefit from other infertility treatments such as in vitro fertilisation (IVF) or intrauterine insemination (IUI).

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