Answer from: Sibte Hassan, MBBS, FCPS, MRCOG, MSc
The extent of the problem is not related with the extent of the symptoms. Patient could have symptoms of pain or sub-fertility but she could have very minimal or mild endometriosis. Interestingly, she could have severe endometriosis when we classify her or stage her disease but she could achieve pregnancy on her own. The stage of the disease has got nothing to do with the actual symptoms which could be different – which is interesting in this disease.
Answer from: Tomas Frgala, PhD
Certainly it does. It may be one of the reasons why the patient actually starts the IVF or the couple starts the IVF process. If the endometriosis happens to grow directly in the ovaries, lowers the ovarian reserve, then that might be one of the causes for infertility, for the problems in the couple.
Answer from: Ahmed Elgheriany, MRCOG, MD, MSc
The link between endometriosis and fertility could be by two things: by anatomical problem inside the pelvis or by the function of the ovaries and endometrium. Let’s start with the anatomical problems. This endometriosis gland, as we mentioned, can form scar tissues in your tummy and this scar tissue per se could obstruct the tube which is a canal between the ovary and the womb (transfers eggs). It can obstruct it with many adhesions, it can destroy all the tubes or sometimes it can form an endometriosis cyst and this cyst could get bigger and just press the ovary itself and just decrease the ovarian reserve over time. Sometimes it could be the toxins that come from the endometriosis gland itself. Endometriosis gland itself can secrete toxins on the pelvis – it’s making something called toxic pelvic syndrome. This can affect the quality of the eggs coming from the ovary, this can even affect the embryo resulting from the endometriosis ladies. So it may have an effect on the functioning of the ovary and the hormone axis in the body and could be the cause of the anatomy and the autoimmunity related to the endometriosis itself. It’s one cause of repeated miscarriage so because your body’s autoimmune system is not properly working with endometriosis, trying to send some cells called macrophages which is just eating all these nasty nodules inside your tummy and these nodules can just disturb all your immunity, increasing inflammatory markers in your blood, increasing it’s something called the natural killer cells – all this autoimmunity can affect the lining of the womb itself, can affect the environment that the future embryo will be inside and causing repeating miscarriage. The only strange thing is that maybe, it’s 20% that unexplained infertility happened because of it. So it may be causing repeating miscarriage. This is something that could be related to endometriosis.
Answer from: Anu Chawla, MRCOG, MBBS, M.S., DNB
endometriosis can definitely affect fertility starting from sometimes the woman is not even able to have a frequent sexual intercourse so so the problem could be as simple as that. If at all we’re doing IVF, in such a case then, if the genetically tested normal euploid blastocyst is there then, the chances are pretty much good. IUI intrauterine insemination also has a place in cases of mild endometriosis. Sometimes, these patients sub-clinical endometriosis never gets diagnosed and these patients get classified as unexplained subfertility patients because no one did the laparoscopy and the subclinical or small patches would not show in the ultrasound so, a completely normal ultrasound does not mean that the woman does not have endometriosis because the gold standard of the diagnosis of endometriosis is a surgery which is a laparoscopic surgery and the surgery has to be done when it is indicated so, we cannot just do a laparoscopic surgery just to diagnose. Sometimes these patients get classified as the unexplained group of sub-fertility patients but actually they might actually have the mild or subclinical endometriosis and such patients will benefit from intrauterine insemination so, all three options are there for them: the sexual intercourse and IUI intrauterine insemination or the IVF but like I explained maybe in future, we would assume that as far as if IVF outcomes are concerned, they might not be very different if at all we actually do have the normal euploid genetically tested normal blastocyst.
Answer from: Andrew Horne, Professor
The link between endometriosis and infertility is uncertain in terms of we don’t really understand the mechanism of why it does sometimes lead to infertility. We think it may be due to the fact that the disease may alter the environment, so for where the ovaries are, where the embryos are, etc. That may have some impact upon the early stages of a pregnancy but really we don’t fully understand that link between the two problems.
How it may impact fertility?
We need to keep in mind that most women with endometriosis will get pregnant naturally and no medical intervention would be needed. Women with severe endometriosis which is described as stage III/IV also have a chance of getting pregnant naturally after the surgical removal of the tissue. Small part of them would need assistance with IVF.
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