Experts think that as many as four out of 10 women with fertility problems have endometriosis. Severe endometriosis is a known cause of infertility, but even the mild form may make it hard to get pregnant.
Having endometriosis means the type of tissue that lines your uterus (called the endometrium) is growing in other places, too. Endometrial implants usually grow on organs in the abdomen, such as the ovaries, fallopian tubes and intestines. These implants behave like the tissue in your uterus: they bleed each month when you have your period. This irritates the nearby tissue and can cause cysts and adhesions. Adhesions are bands of scar tissue that can bind the ovaries, tubes and other organs together. This may interfere with conception.
Endometriosis often causes pain and abnormal menstrual periods. In some women, though, infertility is the first symptom they have.
Treatment steps for infertility
Doctors often suggest a stepwise approach to treating infertility caused by endometriosis. In general they start with the easiest and cheapest methods, such as lifestyle changes or minor surgery. If these don't work, more invasive and costly methods may be tried. This includes in vitro fertilization (IVF).
Step 1: Identify and treat reversible causes of infertility.
Your doctor will check both you and your partner to find and treat any other problems that could cause infertility. If none are found, you may be coached on the best days of your menstrual cycle to have sex. Your lifestyle can affect your fertility, so it's best to maintain a healthy weight, avoid alcohol, not smoke and limit caffeine.
Step 2: Have laparoscopic surgery to remove areas of endometriosis.
Your doctor may suggest laparoscopy to diagnosis and treat the condition. For this procedure, the surgeon makes one or more small incisions in your abdomen and inserts a lighted instrument. The doctor can see any implants and adhesions and remove them at the same time. Your chance of getting pregnant may improve for six to nine months after the surgery.
Step 3: Use fertility drugs along with intrauterine insemination (IUI).
Medications are used to stimulate your ovaries to produce one or more eggs. Then sperm is then put through the cervix directly into your uterus. This increases the chance that it will reach and fertilize an egg.
Step 4: Have in vitro fertilization (IVF).
For IVF, you are given drugs that cause your ovaries to make multiple eggs. The eggs are removed from your body body by laparoscopy and mixed with sperm (from your partner or a donor) in a lab. The fertilized eggs are then put into your uterus to grow.
IVF is expensive and time-consuming, but it may offer hope for women with moderate to severe endometriosis who aren't helped by surgery or medication. The main risk of IVF is multiple pregnancy.
The success of IVF depends in part upon your age. It results in pregnancy about 35 percent of the time in women younger than 35. This drops to 15 to 20 percent for women between ages 38 and 40.
Timing of treatment
Several factors will play a role in how quickly you move through the treatment steps. These include:
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