For people who are ready to start their families, finding out there are fertility issues can be a challenging diagnosis to receive. Infertility affects over six million people in the United States, according to the American Pregnancy Association. However, there is still hope for people to have a natural pregnancy if they desire; various methods of medical intervention are available to help couples dealing with infertility.

Key Takeaways

  • A study found that those who knew they had endometriosis before starting fertility treatments had a better rate of success.Having the endometriosis diagnosis allowed individuals to choose the treatment method that worked more successfully with the condition.Endometriosis may impact up to 11% of the female population and can cause problems conceiving.

In fact, the Centers for Disease Control and Prevention note that over 300,000 assisted reproductive technology cycles were performed in the United States in 2018. Now, findings from a new study show that a proper diagnosis of endometriosis for people affected may impact the success of those treatments.

The study, published in Human Reproduction, notes that when endometriosis is diagnosed before reproductive treatments start, it may improve the chance of successfully conceiving. The findings can help those dealing with endometriosis select a treatment plan that can provide a better chance of becoming pregnant.

What Is Endometriosis?

The Office on Women’s Health notes that endometriosis occurs when tissue similar to what lines the womb grows outside of the uterus. Individuals of childbearing age, particularly in their 30s and 40s, can deal with the condition and have problems conceiving.

Endometriosis can cause painful cramps or spotting between menstrual cycles. Pain during sexual intercourse and painful bowel movements can also be symptoms. Digestive problems and infertility can also be indicative of endometriosis. Some people have no symptoms at all, which can make it difficult to know if testing is needed to uncover a diagnosis.

According to the Office on Women’s Health, the condition may impact up to 11% of the female population. While experts say definitive causes are not known, genetics may play a part. Other potential causes may include immune system disorders, menstrual flow issues, hormones, or even accidental scarring during abdominal surgery.

Jennifer L. Lew, MD

Surgery diagnoses endometriosis but does not cure or fix the endometriosis; so, the problem remains but now the patient has the diagnosis.

How Endometriosis Impacts Fertility

The internal damage may be what leads to fertility issues.

“Usually, it is the inflammation and pelvic scarring that some have from endometriosis that we think causes the fertility decrease. This is especially the case if the patient has scarring of the fallopian tubes,” says Jennifer L. Lew, MD, who practices at Northwestern Medicine OBGYN in Sycamore, IL.

While a pelvic exam, ultrasound, or MRI may point doctors in the right direction, the only way to concretely diagnose endometriosis is through surgery. What’s more, there’s no known cure for the ailment, but medicine and surgery can help.

“Surgery diagnoses endometriosis but does not cure or fix the endometriosis; so, the problem remains but now the patient has the diagnosis,” notes Dr. Lew.

That diagnosis is what counts—because it can help someone decide on a course of fertility treatments that are more effective with endometriosis.

“For women [with endometriosis] trying to conceive, they may want to consider going straight to IVF rather than using IUI, but again that is a decision for an individual woman to make in consultation with her doctor,” Dr. Moss adds.

Research shows that those with endometriosis who received IUI treatment experienced a 30% reduction in successfully becoming pregnant.

About the Study

Researchers with The University of Queensland gathered data from 1996 to 2018 on more than 1000 women from the Australian Longitudinal Study on Women’s Health. The participants were born between 1973 to 1978 and had received at least one cycle of in vitro fertilization (IVF) or intrauterine insemination (IUI) infertility treatments.

About a third of the women had endometriosis; a portion of that group was not diagnosed with the condition until after starting fertility treatments. Their health information was linked with data on birth outcomes, allowing investigators to see what impact the condition had on treatments.

“We found that the outcomes of fertility treatment were the same for women with and without endometriosis, but only if the endometriosis was diagnosed before starting fertility treatment,” explains Katrina Moss, PhD, a postdoctoral research fellow at the Centre for Longitudinal and Life Course Research at The University of Queensland.

Katrina Moss, PhD

Women whose endometriosis wasn’t diagnosed before they started fertility treatment did more cycles on average, were more likely to use IUI instead of only IVF—which is the recommended treatment—and were less likely to give birth.

Dr. Moss, the lead author of the study, noted the detrimental impact of not having a prior diagnosis.

“Women whose endometriosis wasn’t diagnosed before they started fertility treatment did more cycles on average, were more likely to use IUI instead of only IVF—which is the recommended treatment—and were less likely to give birth,” she notes.

Despite these limitations, the study highlights the fact that if a diagnosis for endometriosis is given before starting assisted reproductive treatments, it may save time, mental and psychological effort, and money, by selecting the right type of treatment.

While the results are insightful, investigators acknowledge that they did not know the severity of participants’ endometriosis. Researchers also didn’t know why the participants opted for reproductive treatments. That means other factors, not just the endometriosis, may have played a part in whether or not each person was able to conceive. Additionally, there was not a definitive confirmation that the live births were the direct result of the infertility treatments.

Moving Forward to Conceive

Medical conditions are one of many factors that can hinder a person’s ability to become pregnant. Being aware of your symptoms and proactively seeking solutions with your healthcare professional can be a step in the right direction towards your desired outcome.

What This Means For You

When you have trouble conceiving, it can take a toll on you mentally, physically, and emotionally. Making the decision to undergo fertility treatments can also be challenging. If you think you may have endometriosis, reach out to a healthcare provider. They can help you receive a proper diagnosis and make choices about fertility treatments that may work best for your desired outcome.