Fertility and Endometriosis
First and foremost, it is important to know that endometriosis is by no means synonymous with infertility, it is simply a risk factor. The majority of women who have endometriosis have no difficulty in conceiving. On the other hand, among infertile women, approximately one third have endometriosis. This distinction is fundamental and is often misunderstood by both the media and patients. Taking into account a woman’s fertility at the time of diagnosis of endometriosis is nevertheless essential, for several reasons.
- The first treatment for endometriosis is medical-hormonal. It consists in blocking menstruation so as to prevent the pain of menstruation (also called dysmenorrhea), improve other pain and stop the disease from progressing. However, all treatments that suppress menstruation are contraceptive and necessarily have to be stopped for conception to occur. This timing of discontinuation of contraception is therefore very important, and can be accompanied medically, from an early stage to limit the episodes of menstruation and optimize the chances of pregnancy.
- The disease may have affected fertility, and this change should be evaluated. If necessary, fertility protection can be considered.
- In case of recourse to surgery, even in the absence of desire for pregnancy, the consequences and benefits for future fertility are to be anticipated and discussed with the patient.
Infertility and Endometriosis
4 mechanisms of the disease, separately or in combination, can cause infertility, which is defined as the absence of pregnancy after one year (or more) of trying to conceive.
This corresponds to obstruction of the fallopian tubes by endometriosis lesions. In some cases, these lesions are repairable, in others not. The fallopian tubes (where the egg and sperm meet) are essential for natural fertility.
Chronic inflammation caused by endometriosis can create a climate in the lower abdomen and genital organs that is unfavourable for the egg and sperm to meet, resulting in fertilization failure.
Impaired ovarian reserve
Endometriosis ovarian cysts (also called endometrioma) can destroy a woman’s egg supply. Surgery to remove these cysts, if poorly undertaken, can make this situation even worse.
Endometriosis can cause permanent pain, and/or pain during sexual intercourse. This can make regular sexual intercourse which is necessary to achieve a pregnancy, more difficult.
In the case of proven infertility associated with endometriosis, a comprehensive treatment plan that includes the partner is required.
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