Managing the endometriosis patient through their fertility journey

In the UK, it is estimated that one in 10 women of reproductive age is affected by endometriosis, translating to roughly 1.5 million women. Trustee of The Endometriosis Foundation and executive committee member of the British Fertility Society, Ms Srividya Seshadri has recently co-authored an exploration of endometriosis management for IVF patients.

Published in the specialist journal The Obstetrician and Gynaecologist, this seemed an opportune moment to give a more patient-focused rundown on the intricacies of fertility treatment for endometriosis patients.

Endometriosis and fertility

Endometriosis is a painful condition that is characterised by the growth of womb-like tissue outside of the uterus. Because this tissue cannot exit the body in the usual way – through menstrual bleeding – this leads to the formation of scar tissue, causing obstruction and pain in the pelvic region.

Although there is some association between endometriosis and fertility problems, the condition does not necessarily cause infertility, and some women with very severe endometriosis have been able to conceive naturally. However, studies have suggested that roughly 25% to 50% of infertile women have endometriosis, and about 30% to 50% of women with endometriosis are infertile.

The exact reason for this is not yet fully understood, but in some cases, it may be linked to the formation of scar tissue, causing distortion of the abdominal organs, or even creating a blockage in the fallopian tubes, preventing eggs from being released. Other possible reasons are that the associated inflammation reduces egg quality or disrupts implantation.

Can IVF help with fertility issues related to endometriosis?

The short answer is, yes. By extracting eggs directly from the ovaries, IVF treatment can circumvent many endometriosis-related fertility problems, and success rates among IVF patients with endometriosis are reassuringly high. However, there may be some adjustments to the standard IVF protocol that are necessary for patients with endometriosis.

Pre-IVF evaluation of symptoms

Before undergoing fertility treatment, it is necessary to assess the severity of the endometriosis symptoms and the impact it is having on your reproductive organs and ovarian reserves. This may include MRI or ultrasound scans.

Surgery to remove endometrial lesions

Although there is evidence to show that surgical treatment of endometriosis can be beneficial for the success of IVF, there is a risk that the surgery itself can diminish ovarian reserves, so currently this is only recommended for patients with severe lesions that block access for egg retrieval.

Hormone therapy and GnRH agonists

Historically, patients with endometriosis have been prescribed a prolonged (3-6 month) period of treatment with GnRH agonists and hormone therapy to treat the symptoms of endometriosis before IVF. However, evidence for the benefits of this on the success of fertility treatment is minimal, and it is now only recommended for patients who have undergone surgical removal of lesions, to prevent the recurrence of endometriosis symptoms.

Whilst all technologically assisted fertility treatments are available to patients with endometriosis, IVF has the strongest evidence base to support its use.

Endometriosis and pregnancy

Patients are often concerned about the impact that endometriosis will have on pregnancy, if they can conceive. The good news is that generally, the pain associated with endometriosis improves during pregnancy – although there are some exceptions to this rule, and it is likely to return soon after giving birth.

There are also some increased risks associated with endometriosis in pregnancy – the risk of miscarriage rises from 1 in 5 to 1 in 4, and patients with endometriosis are more than twice as likely to experience an ectopic pregnancy as those without the condition – although the risk is still very minimal.

When you undergo fertility treatment with Aria, we will always offer the treatment with the best evidence base for you, and monitor your fertility journey every step of the way, so you can rest assured you’re in the best possible hands.

For more information, please get in touch with us.