Endometriosis affects approximately 1 in 10 women and an unmeasured number of transgender, non-binary and gender-diverse individuals. Endometriosis is a condition where cells that resemble the types of cells that make up the uterine lining (the endometrium) are found outside of the uterus. Infertility is one of the most common symptoms of endometriosis, the other being pain (including painful periods, painful sex, or chronic pain). 

While endometriosis is a common cause of infertility, not everyone with endometriosis struggles to conceive. And for those that do, many are able to achieve a successful pregnancy with the right support and treatment. 

How does endometriosis impact fertility?

We don’t fully understand all the ways in which endometriosis impacts fertility, and it’s likely different for different people. Endometriosis causes inflammation and it can sometimes lead to scar tissue formation in the pelvis which, in turn, may block one or both of the fallopian tubes. Endometriosis can also lead to a decrease in someone’s egg count (ovarian reserve) or have a negative impact on their egg quality. This is particularly true if endometriomas (ovarian cysts made up of endometriosis implants) are present. In other cases, we think that endometriosis (perhaps together with a similar condition called adenomyosis) can impair the ability of embryos to implant into the uterus. 

What treatments are available for people with endometriosis and infertility?

Every person’s experience with endometriosis and fertility is unique, and there is no one-size-fits-all treatment. It is important to work together with a team of healthcare professionals to formulate a personalized plan that is right for you, taking into account your individual values, needs and goals. 

Some people will decide that surgery for endometriosis is right for them, whereas other people may decide to forgo surgery and focus on fertility treatment like IVF. Some people will benefit from a combination of both surgery and fertility treatment. Medical (hormonal) therapy can be effective in treating endometriosis pain, and is sometimes used before or after surgery or fertility treatment but cannot be used when someone is trying to conceive. 

In addition to expert physicians such as fertility specialists and endometriosis surgeons, people with endometriosis may find it helpful to work with a team of clinicians that include pelvic floor physiotherapists, dieticians, counsellors, and many more. 

What resources are available to support someone with endometriosis? 

Endometriosis can have a profound impact on people’s moods and it can also cause tremendous strain on relationships, whether they be with friends, family members or significant others. This is often made worse by the fact that too many people with endometriosis have long delays in getting a diagnosis or receiving appropriate treatment. It can feel lonely and isolating. Finding the right healthcare professionals and support groups (whether they be formal or informal) can help provide expertise and encouragement along your journey.

If you or a loved one are struggling with endometriosis and fertility, we always recommend  connecting with a healthcare provider. There is hope, and with the right resources and support, you can achieve your dream of starting a family. 

Dr. Rhonda Zwingerman is a Reproductive Endocrinologist and Infertility Specialist, Twig’s Medical Director and co-founder.

Source: Gynaecology Quality Improvement Collaboration & The Endometriosis Network Canada