How are endometriosis and fertility related?
The exact mechanisms by which endometriosis can lead to fertility problems are not known. However, several factors such as decreased egg quality, inflammatory and immune response to the extraneous endometrial growths, decreased ovarian reserve, anatomical distortions in the pelvis, and altered prostaglandin secretion could be causing infertility.
What is an ovarian reserve?
Ovarian reserve denotes a woman’s fertility potential. However, it only gives us information about the number of her eggs. Ovarian reserve naturally decreases with age, but this varies from person to person.
How does endometriosis affect ovarian reserve and fertility?
Endometriosis can lead to inflammation in the reproductive tract, as well as possible reduced blood flow near the ovaries due to the formation of scar tissue. All of these can thwart the maturation of eggs and reduce their quality and quantity.
Does infertility correlate with the stage of endometriosis?
the American Society for Reproductive Medicine (ASRM) classifies endometriosis into four stages with stage 1 being the mildest and stage 4 being the most severe based on criteria such as the location of the disease, the extent and depth of endometriosis implants, the presence and size of ovarian endometriomas (chocolate cysts), and the presence and severity of adhesions.
This staging does not correlate with the severity of symptoms. However, it can give an indication of the possibility of infertility.
How can fertility be evaluated?
There are several tests that can determine whether or not a woman is fertile. This also includes taking into account her medical history and previous pregnancies. Some of the diagnostic methods to determine fertility include:
- Imaging techniques such as transvaginal ultrasound, sonohysterography, and hysteroscopy
- Blood tests to determine the levels of hormones such as estradiol, follicle stimulating hormone (FSH), anti-mullerian hormone (AMH)
- Hysterosalpingogram (HSG) to evaluate fibroids and polyps in the fallopian tubes as well as whether the fallopian tubes are open for passage of eggs and embryos
- Laparoscopy to visualize reproductive structures and remove scars and endometrial lesions for diagnosis and treatment.
How are FSH and AMH levels useful in determining egg quality?
Egg quality cannot be determined by laboratory work alone, and can only be determined in the in vitro fertilization (IVF) setting once fertilization is attempted.
Measuring the levels of FSH and AMH may help indirectly determine egg quality, however, a woman’s age is the biggest predictor of egg quality.
AMH plays an important role in promoting egg development after puberty and levels of this hormone correlate with the ovarian reserve.
Similarly, FSH, a pituitary gland hormone, also supports the maturation of the ovaries and ovulation in each monthly cycle. While FSH levels can fluctuate daily during the monthly cycle, a lower or higher than the normal level for a certain age can be indicative of fertility issues. Generally, high levels of FSH and/or estradiol at day 3 of the cycle are indicative of lower fertility rates.
What other tests can help evaluate fertility?
Apart from imaging and blood tests, your fertility expert or healthcare provider may also recommend a few other tests. These include:
- Clomiphene citrate administration early in the menstrual cycle. High levels of FSH before and after the administration of clomiphene citrate is suggestive of lower pregnancy rates.
- Counting small (2 mm – 10 mm in diameter) antral follicles in the ovary via transvaginal ultrasound done early in the menstrual cycle.
- Evaluating the response to gonadotropins (FSH or FSH + luteinizing hormone) to stimulate the growth of many eggs at once. The response to gonadotropins based on the dose may reflect fertility status.
Is there a natural way to increase ovarian reserve?
There is no direct method of improving ovarian reserve. However, studies have shown that an omega-3 fatty acid-rich diet can delay ovarian aging and improve egg quality. Another substance that may improve egg quality is co-enzyme Q10, which is found in fish, spinach, lentils, and soybeans. It is also available as a supplement. Please note that you should first consult with a healthcare professional prior to taking supplements.
What are your reproductive options if you have endometriosis?
There are several assisted reproductive techniques (ARTs) that can help if your natural fertility is affected due to endometriosis. These include:
- Intrauterine insemination (IUI)
- In vitro fertilization (IVF)
Are IUI and IVF definitive methods for conception?
The success of IUI and IVF is directly dependent on the quality of your eggs.
IUI relies on properly functioning fallopian tubes and ovaries, so any blockage or scarring in these tissues can affect the success rates of the technique.
If your egg quality is low, this can affect the chance of success of both IUI and IVF. In such cases, using donor eggs may be an option.
Can treating endometriosis improve fertility?
Laparoscopic deep excision surgery is the gold standard method for removing all kinds of endometriosis lesions. The surgeons at Seckin Endometriosis Center (SEC) are highly skilled and can completely excise all endometriosis lesions including those that are deep-infiltrating.
The aim of this technique is to preserve your natural fertility as much as possible while also increasing the chance of success of assisted reproductive techniques.
Why is laparoscopic excision surgery better than other forms of surgery?
Laparoscopic excision surgery removes any scar tissue on or near the reproductive organs. This is aided by our patented Aqua Blue Contrast (TM) technique that helps in the excellent visualization of endometrial lesions. We use a cold excision technique without using electricity or heat to remove scar tissue. This leaves healthy tissue intact and provides lasting relief while preventing any resultant fertility problems.
Can treating endometriomas with excision surgery help preserve fertility?
Yes. If we find that endometriosis affects your ovaries, we make sure that we only remove the endometrial lesions while preserving the structure and function of your ovaries as much as possible. We are able to reconstruct the ovary to allow for the maximum number of healthy follicles without destroying unaffected ovarian tissue.