Endometriosis stands as one of the most prevalent diseases affecting women with menstrual cycles during their childbearing years. Approximately 1 out of 10 women, totaling about 190 million globally, grapple with this condition, as reported by the World Health Organization (WHO). Shockingly, many women with endometriosis remain unaware of their diagnosis, given that it typically takes 7-10 years to identify.

This condition involves tissue similar to the uterine lining (endometrium) growing outside its usual area (within the uterus), causing various symptoms such as intense pain, scarring, and potential infertility.

Picture the uterine lining not exiting through the cervix but instead building up in your body cavity, settling anywhere like on the bladder, intestines, or ovaries 😳. Then, during menstruation, imagine this tissue bleeding internally into your abdomen, causing not just pain but also potential scarring. A little vivid, we know, but it’s the unfortunate reality for some, who experience endometriosis.

In this blog post, we showcase how endometriosis can cause significant discomfort and, regrettably, hinder conception due to scarring that may impede the union of egg and sperm.

What are the symptoms of endometriosis?

• Painful period cramping

• Abdominal discomfort

• Back pain, especially during periods

• Pain during sex

• Trouble conceiving

• Chronic fatigue

• Painful bowel movements

Why is endometriosis so under-diagnosed?

Despite its prevalence, diagnosing endometriosis proves challenging. Not all patients exhibit the same symptoms, and research published in the Journal of Assisted Reproduction and Genetics suggests that up to 25 percent of women with endometriosis experience no symptoms at all.

Dr. Mark Trolice, an infertility specialist at Florida’s Fertility Care IVF Center, notes that many of these symptoms resemble other conditions, leading to difficulties in identification.

Typically, patients initially report symptoms to their primary care physicians, who may prescribe NSAIDs like ibuprofen or Tylenol.

If complaints include painful intercourse and menstruation, referral to a gynaecologist often follows, with the recommendation of monitoring symptoms for three to six months while using birth control pills. The delay in diagnosis, sometimes up to a decade, is often attributed to the masking effect of birth control.

How is endometriosis diagnosed?

A definitive diagnosis of endometriosis requires a laparoscopic surgery, a procedure involving small incisions in the abdominal or pelvic region to visualise internal organs. It is considered the gold standard method to diagnose endometriosis, either via a biopsy of the tissue or via direct visualisation.

Dr. Mary Jane Minkin adds that while laparoscopy allows for identifying endometriosis, it bears the risks of abdominal surgery and is only recommended when essential.

Alternatively, a less invasive method called ReceptivaD examines an inflammatory marker named BCL6 through an endometrial biopsy. Dr. Allison Rodgers, an OB/GYN and reproductive endocrinologist at Fertility Centers of Illinois, explains that this biopsy, ideally performed post-ovulation or within the last two weeks of the menstrual cycle, takes a few minutes. However, it isn't infallible, occasionally yielding positive results for other pelvic inflammatory conditions like hydrosalpinx. Additionally, ReceptivaD often incurs out-of-pocket costs around $700, as it's typically not covered by insurance.

If you suspect you may have endometriosis, here's what you can consider:

Firstly, it's crucial not to panic upon receiving a diagnosis. Though any diagnosis related to your reproductive system can be daunting, remember that you're not alone. Endometriosis doesn’t directly mean infertility, it just provides a few extra hurdles to cross, when you’re trying to conceive.

Can endometriosis affect fertility? Not always.

In short, yes, endometriosis can affect your chances of conceiving and carrying a pregnancy to term. According to the Centers for Disease Control and Prevention (CDC), approximately 30 to 50 percent of women with endometriosis may encounter infertility, contrasting with up to 19 percent in the general population.

Dr. Minkin notes, "Conceiving with endometriosis might pose challenges due to scarring and ovulation difficulties associated with the condition. Furthermore, medications used in endometriosis treatment, including birth control pills, can impede pregnancy. Hence, for mild cases, attempting conception for a few menstrual cycles might be encouraged."

It's essential to discuss potential pregnancy complications with your doctor if you suspect having endometriosis. The condition elevates the risk of miscarriage and is linked to various pregnancy-related complications such as preterm birth, placenta previa, hypertension, and more, as highlighted by Dr. Martin. Although the likelihood of these complications seems relatively low, further research is needed to establish definitive correlations.

Getting pregnant with endometriosis

If you're considering pregnancy while dealing with endometriosis, prioritize having bloodwork done, whether through your regular OB-GYN or a fertility specialist. An "AMH test," a simple blood draw, assesses your ovarian reserve—a crucial step for family planning, particularly for endo patients who may experience faster egg loss, as noted by Dr. Rodgers.

On the other hand, egg freezing is also a viable option, where your mature eggs are frozen and stored for ICSI.

For some endometriosis patients, IVF might not be necessary; conception occurs naturally or with fertility medication like Clomiphene (Clomid) or Letrozole, encouraging ovulation. Your provider might suggest timed intercourse or intrauterine insemination (IUI) in conjunction with these medications.

Interestingly, pregnancy itself can alleviate some symptoms, as heightened hormones like estrogen and progesterone tend to suppress endometriosis symptoms.

From Arva

An endometriosis diagnosis might come as a shock, but it doesn't signify the end of your parental aspirations. In reality, most individuals diagnosed with endometriosis conceive, many naturally and others with fertility support.

Your voice matters significantly if you're dealing with endometriosis; speaking up and advocating for yourself are crucial steps. If you suspect you have it, don't hesitate to assertively advocate for your needs.

At Arva we provide you all the right resources , fertility tests and information needed to make informed decisions towards a proper diagnosis and comprehensive care—especially when you’re trying to conceive.