The truth about endometriosis, fertility

There is a long list of factors that can affect a woman’s ability to have a child. This often includes everything from age to risky health habits such as smoking. A cause of infertility that is increasingly more common, however, is a condition known as endometriosis. Luckily, it doesn’t necessarily mean a woman is sentenced to never having a child.

Endometriosis is when the cells or tissue that should be lining the uterus or womb grow outside of this cavity and cause symptoms including severe pain when menstruation occurs.

Some women never suffer any symptoms, however, Dr. Susan Schy, an obstetrics/gynecology physician with Advocate Lutheran General Hospital in Park Ridge, Ill., says the first symptom is extreme pain either with your menstrual cycle or chronically.

Womenshealth.gov cites other symptoms that may indicate endometriosis, which include:

• Chronic lower back and pelvic pain
• Pain during or after sex
• Intestinal pain
• Spotting or bleeding between periods
• Fatigue
• Constipation, diarrhea, nausea or bloating, especially during your period

The condition interferes with fertility because it can cause problems with ovulation, says Dr. Schy, as the scarring and cysts can affect how the Fallopian tubes and ovaries function.

There is hope, however. “Fertility doctors will help with in vitro fertilization (IVF), bypassing your own Fallopian tubes and any pelvic scarring,” says Dr. Schy. With IVF, a woman stimulates her ovaries to release several eggs by taking hormones. These eggs are then fertilized in a lab and then implanted in the uterus.

To determine if you do in fact have the condition, a doctor will usually perform a pelvic exam to check for larger cysts or scarring behind the uterus and an ultrasound to view any ovarian cysts that may have formed.

Dr. Schy says that many times there are microscopic lesions of endometriosis that cannot be seen so sometimes women will be started on medication to suppress ovarian function such as birth control pills, which can help alleviate pain and discomfort.

To determine if the condition is in fact endometriosis, particularly when pain is chronic, laparoscopy may be performed, where the pelvic organs are examined by an instrument inserted through the abdominal wall called a laparoscope.

“A diagnosis is made at the time of laparoscopy, at which time it can be treated by removing the lesions or correcting problems with the Fallopian tubes and the ovaries,” says Dr. Schy.

If the endometriosis is more pervasive, it may require abdominal surgery or laparotomy where growths are removed from the pelvis or abdomen. In severe cases, a hysterectomy or removal of the uterus is done. Dr. Schy adds that hysterectomy may be an option if a woman has already had children, however, it is not recommended for young women.

Dr. Schy wants women to be aware that endometriosis is not the prime cause of infertility. “It’s possible that it could be something else so make sure to work with your physician to understand the full picture of your reproductive health to rule it out,” she says.