Pu­blished: 8. Fe­bruary 2022 | Up­dated: 25. Au­gust 2023 Author: Saskia Balke-Hom­berg | Re­viewed by Saskia Balke-Hom­berg

En­do­me­triosis & in­fer­ti­lity

What is en­do­me­triosis?

En­do­me­triosis is a di­sease whose name is de­rived from “en­do­me­trium”, the me­dical term for the li­ning of the uterus. Af­fected women ex­pe­ri­ence be­nign, often very painful growths out­side the uterus, for ex­ample in the ab­domen, in­testines or ova­ries. The Fe­deral Center for He­alth Edu­ca­tion and the En­do­me­triosis As­so­cia­tion esti­mate that 40,000 new cases are dia­gnosed each year in Ger­many. Overall, ex­perts be­lieve that bet­ween 5 and 15% of all women of child­bea­ring age are af­fected.

Dif­fe­rent de­grees of se­ve­rity and stages of the di­sease

1. pe­ri­to­neal en­do­me­triosis

En­do­me­triosis le­sions can form all over the pe­ri­to­neum, but they are more common in the lesser pelvis.

2. ova­rian en­do­me­triosis

The growths occur around the ova­ries.

3. deep in­fil­t­ra­ting en­do­me­triosis (TIE).

En­do­me­triosis le­sions occur in or­gans such as the uri­nary bladder, va­gina, and bowel.

4. ade­no­myosis uteri

When the growths are also found in the ute­rine muscle, it is called ade­no­myosis. This form of en­do­me­triosis fur­ther re­duces fer­ti­lity.

Why does en­do­me­triosis often lead to in­fer­ti­lity?

Af­fected women can in ge­neral be­come pregnant, but fer­ti­lity is li­mited de­pen­ding on the extent of the di­sease. This is often caused by ad­he­sions in the fallo­pian tubes and ova­ries, which can me­cha­ni­cally pre­vent pregnancy. It is still un­clear whe­ther the ute­rine li­ning is re­co­gnized by the im­mune system as a for­eign body and whe­ther this also causes it to turn against the fer­ti­lized egg.

In ad­di­tion, there are in­di­ca­tions that oo­cyte ma­tu­ra­tion and early em­bryonic de­ve­lo­p­ment may be dis­turbed in af­fected women. En­do­me­triosis pa­ti­ents often have a smaller egg re­serve and go th­rough me­no­pause more quickly.

What is the li­keli­hood of pregnancy in women with en­do­me­triosis?

Re­se­arch has con­cluded that en­do­me­triosis re­duces a wo­man’s fer­ti­lity by about half. In num­bers, this means: While fer­ti­lity in a 35-year-old woman is about 15% per cycle, en­do­me­triosis re­duces it to about 7.5%.

There is no di­rect cor­re­la­tion bet­ween the size of the growths and the pro­ba­bi­lity of pregnancy. Even very small en­do­me­triosis foci can pre­vent pregnancy; on the other hand, even a woman with large foci can get pregnant with en­do­me­triosis wi­t­hout any pro­blems.

En­do­me­triosis causes: How does the di­sease de­velop?

The causes of the de­ve­lo­p­ment of en­do­me­triosis are not yet fully un­ders­tood. Re­se­ar­chers at the Cha­rité hos­pital in Berlin have been able to de­mons­trate the in­ter­ac­tion of the en­do­me­trium with nerve fi­bers. [1] The author of the re­se­arch paper, Silvia Mechsner, re­fers to “mini-uteri” that form muscle fi­bers, nerve cells and glands. She as­sumes that the cause of the com­plaints is to be found in this par­ti­cu­la­rity.

Other theo­ries sug­gest that the en­do­me­triosis le­sions arise di­rectly from stem cells. [2] Ac­cor­ding to re­se­arch, the growth would be trig­gered by in­flamm­a­tion or hor­monal in­fluences. Her­edity also plays a role in the de­ve­lo­p­ment of en­do­me­triosis.

Pre­ven­ting en­do­me­triosis

A ba­lanced diet with plenty of ve­ge­ta­bles, whole grains, good fats and white meat helps re­duce the risk of en­do­me­triosis, ac­cor­ding to a study. Green ve­ge­ta­bles and fruits are espe­ci­ally re­com­mended. In­creased con­sump­tion of red meat, on the other hand, has a ne­ga­tive ef­fect on the risk of di­sease. [3]

Possible cause of infertility

Sym­ptoms of en­do­me­triosis

En­do­me­triosis causes chronic pain that can be so se­vere that it li­te­rally in­ca­pa­ci­tates those af­fected. The dis­com­fort can even occur when going to the toilet or du­ring sex. Often the com­plaints are dis­missed as normal pe­riod pains and the af­fected women in­iti­ally comes to terms with them. This is also the re­ason why on average six to eight years pass be­fore the sym­ptoms lead to re­co­gni­tion of the di­sease.

Ty­pical en­do­me­triosis sym­ptoms

  • Se­vere mens­trual pain
  • Chronic ab­do­minal pain (cycle-de­pen­dent and ‑in­de­pen­dent)
  • Pain when going to the toilet
  • Heavy mens­trual blee­ding
  • Pain du­ring se­xual in­ter­course

Be­cause of these di­verse com­plaints, the di­sease is often only dia­gnosed in the con­text of an unful­filled child wish: 40 to 60% of un­in­ten­tio­nally child­less women are af­fected. [4]

In­fer­ti­lity tre­at­ment for en­do­me­triosis: How you can get pregnant

Even if fer­ti­lity is li­mited in af­fected women, with a little pa­ti­ence they can still ful­fill their de­sire to have children. The first step is al­ways a visit to the doctor to cla­rify the re­asons for the failure to be­come pregnant. The older the woman is, the sooner a cla­ri­fi­ca­tion should take place.

Ful­fil­ling the de­sire to have children de­spite en­do­me­triosis with as­sisted re­pro­duc­tion

Ac­cor­ding to the Na­tional As­so­cia­tion of Sta­tu­tory He­alth Insu­rance Phy­si­cians, for many women af­fected by en­do­me­triosis, the suc­cessful path to pregnancy leads th­rough fer­ti­lity tre­at­ment, such as as­sisted re­pro­duc­tion. Stu­dies have shown that the pro­ba­bi­lity of suc­cess de­pends on the egg qua­lity. Im­plan­ta­tion does not seem to be dis­turbed in en­do­me­triosis pa­ti­ents.

Tre­at­ment of en­do­me­triosis by sur­gery

Not every af­fected woman suf­fers from en­do­me­triosis and re­quires the­rapy. Ho­wever, half of the af­fected pa­ti­ents have to ad­just to a per­ma­nent tre­at­ment until me­no­pause usually leads to the ab­sence of sym­ptoms. Women who su­spect en­do­me­triosis due to their sym­ptoms should con­sult a gyneco­lo­gist as early as pos­sible. A test that asks about the sym­ptoms can pro­vide in­itial in­di­ca­tions. Ho­wever, the dia­gnosis can only be con­firmed in­va­si­vely with the help of an ab­do­minal en­do­scopy. In this way, the tissue le­sions are also re­moved.

Ho­wever, en­do­me­triosis sur­gery does not al­ways pro­vide per­ma­nent freedom from sym­ptoms: the risk of re­cur­rence is 30% wi­thin five years, as long as the ova­ries are func­tional and ovu­la­tion oc­curs. If this is not the case, the risk in­creases to up to 80% wi­thin three to five years. [5]

Tre­at­ment of en­do­me­triosis with hor­mone the­rapy.

If en­do­me­triosis sur­gery is fol­lowed by three to six months of hor­mone the­rapy, sub­jec­tive sym­ptoms may im­prove and the time to re­cur­rence of the tissue le­sion may be pro­longed. In ad­di­tion, an in­creased pregnancy rate has been re­corded with the com­bi­na­tion of in­va­sive sur­gery and hor­monal the­rapy [6].

Ac­tively con­fron­ting en­do­me­triosis: dealing with phy­sical pain

Pa­ti­ents dia­gnosed with en­do­me­triosis often feel hel­p­less in the face of their di­sease. Ho­wever, a re­flec­tive and ac­tive life­style helps to better cope with the felt pain and to in­crease the qua­lity of life.

Let the fol­lo­wing sug­ges­tions in­spire you:

  • Keep a pain diary
  • Get plenty of exer­cise and dis­cover new sports
  • Learn re­la­xa­tion tech­ni­ques
  • Try out al­ter­na­tive he­aling me­thods (e.g. acu­p­unc­ture)
  • Open up to your fa­mily or fri­ends
  • Ex­ch­ange in self-help groups

Possible cause of infertility

Con­clu­sion: Be ac­tive to in­crease qua­lity of life and ful­fill your de­sire to have children

En­do­me­triosis is an in­curable but treatable be­nign di­sease. Ac­cor­ding to sci­en­tific fin­dings, a he­althy diet helps to re­duce the risk of the di­sease. If you have any war­ning signs, you should dis­cuss your su­s­pi­cions with a gyneco­lo­gist as soon as pos­sible.

Tre­at­ment should be car­ried out by ex­perts who will tailor the the­rapy to the in­di­vi­dual sym­ptoms and with re­gard to a pos­sible child wish. The com­bi­na­tion of en­do­me­triosis sur­gery and hor­mone the­rapy has proven to be pro­mi­sing in terms of im­pro­ving fer­ti­lity.

An ac­tive and he­althy life­style as well as an opened ap­proach also helps af­fected women to alle­viate their sym­ptoms and gain a better qua­lity of life.

About Fer­tilly

At Fer­tilly, we have made it our mis­sion to ac­com­pany cou­ples (ho­mo­se­xual and he­te­ro­se­xual) and sin­gles on the way to ful­fil­ling their child wish. In doing so, it is im­portant to us to create trans­pa­rency in the area of fer­ti­lity ser­vices, to pro­vide in­for­ma­tion and know­ledge on the to­pics of pregnancy and fer­ti­lity and to help you to find the most sui­table Fer­ti­lity Center. Th­rough co­ope­ra­tion with first-class Fer­ti­lity Cen­tres and cli­nics in Eu­rope, en­qui­ries about Fer­tilly are given pre­fe­ren­tial tre­at­ment. This means that our pa­ti­ents avoid the usually long wai­ting times and get ap­point­ments more quickly.

If you would like more in­for­ma­tion about Fer­ti­lity Cen­ters, suc­cess rates and prices, please contact us using this ques­ti­on­n­aire. We will ad­vise you free of charge and wi­t­hout any ob­li­ga­tion.

  • Answer the first ques­tions in the on­line form in order to book an ap­point­ment. This way we can better ad­dress your needs du­ring the con­ver­sa­tion.

  • We will find the best contact person for your in­di­vi­dual needs. Sche­dule 20 mi­nutes for the con­sul­ta­tion.

  • We will in­tro­duce you to the right fer­ti­lity clinic from our net­work, make an ap­point­ment and ac­com­pany you until your wish for a child is ful­filled.

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  1. Bar­cena de Arel­lano M.L., Ar­nold J., Ver­cel­lino F., Chi­an­tera V., Schneider A., Mechsner S. (2011): Over­ex­pres­sion of the nerve growth­factor (NGF) in pe­ri­to­neal fluid from women with en­do­me­triosis may pro­mo­teneu­rite out­growth in en­do­me­triotic le­sions. In: Fertil Steril, Jg 95 H 3,S.1123–1126
  2. Meyer R: Über den Stand der Frage der Ade­no­myo­sitis und Ade­nome im all­ge­meinen und ins­be­son­dere über Ade­no­myo­sitis se­ro­epi­the­lialis und Ade­no­myo­me­tritis sar­co­ma­tosa. Zbl Gy­näkol 1919; 43: 745–50. 13
  3. Pa­razzini Fet al: Sel­ected food in­take and risk of en­do­me­triosis. Hum­Re­prod 2004; 19(8): 1755–1759
  4. Pa­razzini Fet al: Sel­ected food in­take and risk of en­do­me­triosis. Hum­Re­prod 2004; 19(8): 1755–1759
  5. ebd.
  6. ebd.