Endometriosis affects approximately 30-50% of women experiencing difficulty conceiving. Understanding the relationship between endometriosis and fertility is important for making informed decisions about your care.
How Does Endometriosis Affect Fertility?
Endometriosis can affect fertility through several mechanisms:
- Anatomical distortion: Adhesions and scar tissue can alter the normal anatomy of the pelvis, preventing the fallopian tubes from picking up eggs from the ovaries.
- Ovarian endometriomas: Cysts on the ovaries can damage healthy ovarian tissue and reduce egg reserve.
- Inflammatory environment: The inflammatory changes associated with endometriosis can affect egg quality, sperm function, and embryo implantation.
- Uterine factors: Adenomyosis, which commonly coexists with endometriosis, can affect implantation.
Does Surgery Help Fertility?
The relationship between surgery and fertility in endometriosis is nuanced. For mild to moderate disease, surgical excision of endometriosis has been shown to improve natural conception rates. For severe disease, the decision to operate requires careful consideration of the potential benefits against the risk of reducing ovarian reserve, particularly in women with endometriomas.
Prof Mahmood takes a fertility-conscious approach to surgical planning, considering: - Your current ovarian reserve (assessed through AMH levels and ultrasound) - The extent and location of disease - Your age and timeline for conception - Previous fertility treatments
When Should You Seek Help?
If you have endometriosis and are planning to conceive, early specialist assessment is advisable. You should seek help if: - You have been trying to conceive for 6-12 months without success - You have known moderate or severe endometriosis - You are over 35 and have not conceived after 6 months - You have had previous endometriosis surgery
A Collaborative Approach
Managing endometriosis-related subfertility often involves collaboration between gynaecologists and fertility specialists. Prof Mahmood works closely with fertility teams to ensure a coordinated approach, whether the plan involves surgical treatment, assisted reproduction, or both.
The goal is to optimise your chances of conception while managing your endometriosis symptoms effectively.