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Endometriosis accounts for 21% of infertility causes.

Causes of infertility – endometriosis

Approximately 35% of all patients who reported at infertility treatment clinics are diagnosed with endometriosis, are suspected to suffer from endometriosis or are diagnosed with the disease at the stage of diagnostic tests.

Endometriosis can occur in any woman at a reproductive age, including young and very young women. Since the causes of the disease are not fully known, it is difficult to prevent it. The factors causing this disease include congenital, environmental, epigenetic, autoimmune and allergic ones. 

Endometriosis and fertility

W 96% of endometriosis cases result in reduced fertility or are accompanied by infertility. Therefore, for couples with difficulties in conceiving a child or maintaining a pregnancy, determining the degree of endometriosis has a decisive impact not only on the treatment of the disease itself, but also on the treatment of related infertility.

What is endometriosis?

Endometriosis is a chronic disease characterized by the presence of endometrium, i.e. the tissue lining the uterine cavity, outside the uterus. The foci of endometriosis occur in the fallopian tubes, on the ovaries, on the peritoneum (the serous membrane covering the uterus and the abdominal cavity) and sometimes subperitoneally, near the ureters. Endometrial changes may be present even in the intestines or in the lungs.

Like the tissue found in the uterus, the foci of endometriosis are sensitive to changes in hormone concentrations and bleed every month, contributing to the growth of endometrial cysts (also known as tar or chocolate cysts) in the ovaries. The blood has an irritating effect on the peritoneum, resulting in the appearance of local inflammation, which contributes to the formation of numerous adhesions. With time, the organs of the small pelvis become more and more damaged.

How to recognize endometriosis?

Endometriosis usually develops in an asymptomatic manner or in the presence of non-specific, sometimes minimum symptoms such as gastrointestinal ailments, premenstrual blotting or pain. Pain may occur during the perimenstrual period, but it may also be manifested as continuous pain, pain in the sacral area, pain during the intercourse, urination or defecation. Bloating and diarrhoea can also be a symptom. The first obvious symptom of endometriosis, i.e. cysts in the ovaries, is usually detected by a control ultrasound examination. Diagnosis is made after laparoscopy and the collection of specimen from endometrial foci for histopathological examination. This is currently the only way to diagnose the disease with certainty.

How to treat endometriosis?

The treatment of endometriosis depends on the severity of endometrial lesions, the degree of damage to the ovaries and the condition of the fallopian tubes. The patency of the fallopian tubes and the degree of progression of the disease are assessed during laparoscopic examination, carried out upon the suspicion of endometriosis. Laparoscopy is not only a diagnostic tool, but also a therapeutic procedure that allows for the removal of some foci of the disease and cysts.

Endometriosis can be treated pharmacologically - a woman then takes specifically selected drugs for at least a year, but because of the disappearance of ovulation during the therapy, it is not recommended for patients who are trying to get pregnant. It is worth highlighting that pharmacological treatment does not increase the chances of getting pregnant in the future. According to current medical knowledge and the recommendations of research associations, there is no reason to use pharmacological treatment in women with endometriosis in order to improve their fertility.
Surgical treatment is proposed for infertility secondary to endometriosis, deep endometriosis and endometrial ovarian cysts, if their diameter exceeds 3-4 cm. It is targeted at removing the foci of endometriosis, releasing adhesions or removing cysts. Women planning pregnancy should try to get pregnant after completing the surgical treatment. The lack of results is an indication to use assisted reproduction techniques - insemination and in vitro.

Endometriosis and trying to get pregnant

Endometriosis is a chronic inflammatory condition. Its presence in the female body affects the quality of egg cells, the composition of follicular fluid and peritoneal fluid, increasing its toxicity to the embryo. It also affects sperm cells, reducing their ability to fertilize, as well as the quality of embryos and the success of their implantation.

Even a low degree of endometriosis can make a natural conception much more difficult. Among women with the 1st or the 2nd degree of endometriosis, the percentage of pregnancies conceived spontaneously, i.e. without any medical intervention, is only 3.3% per cycle.

Inseminations

If the laparoscopic examination detects a low degree of endometriosis, a patient who wants to become a mother can undergo hormonal stimulation in 4 to 6 cycles and insemination. The prerequisite is the patency of the fallopian tubes and good quality of the partner's semen. The couple may be referred to 2-3 procedures of intrauterine insemination. The effectiveness of treatment after a year of trying to get pregnant reaches 22%. Then, if insemination attempts fail, in vitro method is recommended.

In vitro

In the case of endometriosis of high (3rd of 4th) degree of severity, in vitro insemination should be performed immediately, because the effects of treatment depend on the age of the woman and the duration of the disease. Both factors affect the quality of the patient's egg cells. Statistical data show that in each subsequent age group the in vitro effectiveness decreases by about 2%, a decrease is also recorded in the cumulative percentage of pregnancies.

Endometriosis vs HDAC3 enzyme

Research by US and South Korean scientists has shown that low levels of histone deacetylase 3 (HDAC3) contribute to infertility in patients with endometriosis. Continued research may lead to the development of methods that could help to conceive and maintain pregnancy in women with endometriosis. Source: Science Translational Medicine.

Diet as a relief in endometriosis

If you want to know more about how diet can affect endometriosis, download the e-book "Diet - relief in endometriosis". The e-book has been entirely prepared by InviMed nutritionists. It contains both useful information and specific recipes having beneficial effects on the health of persons suffering from endometriosis, from pain relief to fertility problems.

An appropriate diet for endometriosis can help to reduce inflammation, reduce pain, improve hormonal balance, improve the functioning of the immune system and generally improve the nutritional status of the body.

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Basic information regarding the processing of personal data Data controller: Medi Partner Sp. z o. o, ul. Cybernetyki 19, 02-677 Warsaw/ Purpose of processing: marketing of own products and services [including profiling], marketing of Medicover Polska* products and services [including profiling] /Legal basis for processing: Your consent/ Recipients of data: Entities processing personal data on behalf of Medi Partner Sp. z o.o. / Rights with regard to the processing of data: the right to withdraw consent to the processing of personal data, right of access to personal data, other rights, as referred to in the detailed information on processing.