Endometriosis and Pregnancy

The word ‘endometriosis’ is a combination of endo and metra, meaning 'inside' and 'womb' respectively. Endometriosis is an estrogen-related, progressive disorder. It affects approximately 10-15% women in their reproductive years, mostly in the age group of 25-35 years. Delayed pregnancy is known to increase the risk of the disease. In most instances, the women may not be aware that they are suffering from this condition, until they have difficulty in getting pregnant. Before discussing endometriosis and pregnancy, let's first take a look at what endemetriosis is.

What is endemetriosis?
The endometrium is a thin lining on the inside of the uterus. Every month during the menstrual cycle, it thickens in response to estrogen, a hormone produced by the ovaries. If there is no pregnancy, the endometrial tissue breaks down and is discharged along with menstruation, through the vagina. However, in women with endometriosis, endometrial tissue grows outside the uterus, imitating and responding to the monthly hormonal cycle in similar manner, but it has no way of leaving the body. So, it implants itself on any organ in the pelvic cavity, like, the uterus, fallopian tube, ovaries, bladder, etc. and interferes with the organ's normal function.

Endometriosis can be diagnosed with the help of physical examination, ultrasound test or a minor surgical procedure called laparoscopy. Endometriosis not only affects a woman's reproductive health but also her emotional well-being. Read more on symptoms of endometriosis.

Endometriosis and Pregnancy - Impact on Reproductive Health
Studies have shown that endometriosis affects a woman’s chances to get pregnant. Women with endometriosis are less likely to get pregnant and are more likely to miscarry than those without. But the situation is not as dismal as it may seem because research statistics show that only 20 percent of the women with endometriosis trying to get pregnant are less likely to conceive. So, out of 100 such women, 80 have no problems getting pregnant.

A woman with endometriosis may find it difficult to get pregnant due to the following reasons:

• Uterus may be unable to support the pregnancy.
• Lesions in the fallopian tubes may interfere with their ability to pick up eggs released by the ovary or implantation of fertilized eggs in the uterus may be blocked.
• Endometriosis can disturb the cycle of egg development and release by the ovaries.
• The peritoneal fluid that normally allows motility of sperm cells, instead destroys them due to endometriosis.
• Experiencing severe pain during intercourse leads to a difficult sex life.

According to the American Society for Reproductive Medicine (ASRM), endometriosis can be divided into four stages: minimal, mild, moderate and severe. However, it must be understood that severity of symptoms may not indicate the extent of the disease.

Preventing the disorder may not be possible as there are no determined causes of endometriosis. However, you are at risk if your immediate blood relative has suffered from the condition or if you have long periods with short cycles. Treatment for endometriosis has to be individualized with each woman, as it depends on different factors, like, how severe the disease is and its location in the pelvic cavity, age of the woman, for how long the woman has been trying to get pregnant and presence of pain or other symptoms.

Endometriosis and Pregnancy - Tackling Infertility
Chances of pregnancy in women with endometriosis are known to increase with the help of infertility treatments. Therefore, the likelihood that women with minimal endometriosis facing difficulty in getting pregnant, is lesser, provided that they do not have any other infertility related problem.

In case of mild endometriosis, controlled ovarian hyperstimulation with intrauterine insemination may be suggested by the doctor followed by IVF and GIFT if required. The doctor may advise the use of therapies for a maximum two years, after which assisted conception may be advised. If it does not show positive results after a maximum of six cycles, in such cases in vitro fertilization may be recommended.

• In Vitro Fertilization: Also known as IVF, this therapy involves surgical removal of egg from the ovary, after which it is fertilized with male sperm outside the body. If the egg is fertilized, the embryo is then transferred to the woman’s uterus. This therapy is used for women with blocked fallopian tubes.
• Gamete Intrafallopian Transfer: Also known as GIFT, it is used for women with healthy fallopian tubes. In this method, the egg and sperm are fertilized in the fallopian tubes.

Recourse through in vitro fertilization may help women suffering with endometriosis to conceive, if she is under 40 years and if ovarian stimulation therapy is successful.

Though these therapies may also prove successful for a woman with moderate endometriosis, the chances of women with severe form of endometriosis getting pregnant is very low. In severe cases where the pelvic anatomy is disfigured, insemination can prove ineffective. On the other hand, though with a comparatively low success rate of 1.5-2 percent, surgical treatment is known to improve chances for pregnancy, when combined with gonadotropin-releasing hormone (GnRH-agonists) therapy, like, Lupron, Synarel or Zoladex. The medication is prescribed over a period of three to six months to control the menstrual cycle. However, the drug therapy is known to show mild to severe side effects in some women.

The various therapies have demonstrated an improvement in chances of pregnancy among women with endometriosis. Statistics indicate that between 35-65 percent of such women become pregnant and chances are highest in the first two years following treatment. However, the chances of pregnancy are inversely proportional to the extent of endometriosis.

During pregnancy, some women with endometriosis may experience the symptoms aggravating during the early phase of their pregnancy. As the uterus is stretched during pregnancy, it pulls scar tissue along with it, causing pain. However, pregnancy is known to improve the symptoms of the condition as it progresses. This is due to increase in the levels of progesterone, which restrains the growth of the endometriosis lesions. Another reason for improvement of endometriosis symptoms could be the lack of menstrual cycle during pregnancy. On the downside, major pregnancy related complications, like, preterm delivery, antepartal bleeding, proteinuria and high blood pressure are the health risks.

Endometriosis is an important women's health issue. Modern technology may help women overcome infertility, the stumbling block between endometriosis and pregnancy, but pregnant women with endometriosis are a high risk group and adequate care is also essential during pregnancy.