Endometriosis is a chronic disease that affects around one in ten women, causing intense menstrual and pelvic pain.
Beyond the physical symptoms, this pathology has a direct impact on fertility due to the inflammation and adhesions the disease causes in the reproductive organs.
We propose to explore the mechanisms by which endometriosis interferes with fertility, and the therapeutic and surgical solutions available to women who wish to conceive despite the complications caused by the disease.
How does endometriosis affect fertility?
Endometriosis is one of the main causes of infertility in women. Through the formation of endometriotic tissue outside the uterus, this disease triggers a series of mechanisms that disrupt the menstrual cycle and reduce the chances of conceiving.
Chronic inflammation and its effects on the genitalia
Endometriosis causes chronic inflammation in the genital organs, notably the uterus, ovaries and pelvic cavity. This inflammation alters the menstrual cycle, can create adhesions around the organs and disrupt uterine and ovarian functions.
Scar tissue sometimes blocks the fallopian tubes, hindering fertilization. For some women, the chances of becoming pregnant are greatly reduced, despite various attempts to conceive.
Impact on ovulation and oocyte quality
Endometriosis has a direct impact onovulation and oocyte quality. Inflammation, sometimes combined with polycystic ovary syndrome, which may coexist in some patients, affects oocyte development.
In addition, endometrial tissue outside the uterus can release inflammatory substances responsible for disrupting the ovarian and uterine environment.
Studies have shown that these endometrial lesions reduce the chances of a successful pregnancy by lowering the quality of reproductive cells and creating an unfavorable environment for conception.
What are the signs of infertility caused by endometriosis?
Endometriosis can be associated withreproductive problems and female infertility. Its symptoms may sometimes be invisible, but other signs, usually painful, may raise the alarm and require in-depth diagnosis to assess the impact on fertility.
Diagnostic imaging, including ultrasound and MRI, as well as symptom assessment, are necessary to determine the impact of endometriosis on ovulatory function and to correlate different symptoms or manifestations of the pathology with a fertility problem.
- Painful periods and pelvic pain: Intense pain during the menstrual cycle caused by adhesions in the mucous membrane is a frequent sign of endometriosis.
- Pain during intercourse: Pain during intercourse may indicate an extension of the lesions into the pelvic region, which may interfere with reproductive function.
- Primary and secondary infertility: Endometriosis can cause primary or secondary infertility after having a first child, depending on the severity of the lesions.
- Tubal obstruction: Scar tissue caused by endometriosis can lead to blockage of the fallopian tubes, preventing the gametes from meeting and reducing the chances of fertilization.
- Ovarian insufficiency: By directly affecting the ovaries, endometriosis can lead to a reduced egg supply.
What can be done to combat infertility associated with endometriosis?
Several treatments and complementary solutions can improve the chances of pregnancy for women affected by endometriosis-related ovarian cysts.
Medical treatments to regulate lesions and inflammation
Hormonal treatments, including contraceptive pills and GnRH agonists, help slow the progression of endometrial lesions. Combined with anti-inflammatories, they relieve pain, reduce inflammation and improve a woman's general well-being.
Aromatase inhibitors, a hormone therapy treatment, are also an interesting option, lowering the levels of estrogen that nourish endometrial tissue. Although these treatments do not cure the endometrioma, they do prepare the body for a pregnancy in better conditions.
Surgery to remove endometriomas
Laparoscopic laser surgery is a preferred solution for destroying endometriosis-related ovarian cysts and reducing adhesions, while preserving the oocyte capital. This minimally invasive procedure aims to restore ovarian function by eliminating lesions while preserving healthy tissue.
This surgery can also improve the chances of successful assisted reproduction by creating a more favorable environment for ovulation and fertilization.
Medically assisted reproduction and complementary approaches
For patients whose infertility persists, medically assisted reproduction (MAP), via IVF or ICSI, is possible. At the same time, stress management, a balanced diet and pelvic physiotherapy are all solutions that improve conception conditions and help reduce symptoms.
Thanks to recent medical advances, solutions for maximizing the chances of pregnancy in women with endometriosis are becoming more diverse and flexible. By combining medical treatments, targeted surgical interventions and assisted reproduction, it is possible to overcome the infertility problems associated with endometriosis.
Despite the complications posed by this disease, the Endometriosis Center offers individualized follow-up and strategies to improve conception prospects.