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]
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
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.
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Sources:
- 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
- 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
- Parazzini Fet al: Selected food intake and risk of endometriosis. HumReprod 2004; 19(8): 1755–1759
- Parazzini Fet al: Selected food intake and risk of endometriosis. HumReprod 2004; 19(8): 1755–1759
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