Infertility and
endometriosis
Fertility and Endometriosis
First and foremost, it's important to know that endometriosis is by no means synonymous with infertility - it's just a risk factor. In fact, the majority of women with endometriosis have no difficulty in achieving pregnancy. On the other hand, about a third of infertile women have endometriosis. This nuance is fundamental, and often misunderstood by the media and patients alike. Nevertheless, taking a woman's fertility into account at the time of diagnosis of endometriosis is essential, for several reasons.
- The first treatment for endometriosis is medical-hormonal. It consists of blocking menstruation, in order to eliminate menstrual pain (also known as dysmenorrhea), improve other pain and halt the progression of the disease. However, all treatments that suppress menstruation are contraceptive, and must be stopped to achieve pregnancy. Stopping contraception is therefore a very important step, and can be accompanied by early medical support to limit menstrual episodes and optimize the chances of pregnancy.
- The disease may have altered fertility, and this must be assessed. If necessary, fertility preservation may be considered.
- In the case of surgery, even in the absence of a desire for pregnancy, the consequences and benefits for future fertility must be anticipated and discussed with the patient.
Infertility and Endometriosis
4 disease mechanisms, alone or in combination, can lead to infertility, defined as the absence of pregnancy after one year (or more) of trying to get pregnant.
Obstructive mechanism
This corresponds to tubal obstruction by endometriosis lesions. Sometimes these lesions can be repaired, sometimes they cannot. The fallopian tubes (where the egg and sperm meet) are essential for natural fertility.
Inflammatory mechanism
The chronic inflammation caused by endometriosis can create a climate in the lower abdomen and genitalia that is not conducive to the egg and sperm meeting, and thus to fertilization failure.
Impaired ovarian reserve
Endometriosis ovarian cysts (also known as endometriomas) can destroy a woman's egg supply. Surgery to remove these cysts, if carried out incorrectly, can further aggravate the situation.
Pain
Endometriosis can cause permanent pain, and/or pain during intercourse. This can be an obstacle to regular intercourse, which is necessary to achieve pregnancy.
In the case of proven infertility associated with endometriosis, a comprehensive approach must be adopted, which also necessarily takes into account the partner.
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