Fertility issues affect 30-50% of women diagnosed with endometriosis. Furthermore, infertility is a common symptom associated with endometriosis. And, while in and of itself endometriosis does not cause infertility. Nor does it mean that a woman with endometriosis is barren and incapable of conceiving. It does mean that there’s a percentage of women that may encounter fertility issues as a result of having endometriosis. Therefore, they may need to seek working with a fertility specialist to discuss applicable treatments to aid in conception.

Fertility Issues You’re Unaware of

Consequently, there are various underlying factors that contribute to infertility for endo sufferers. Many of these complications arise due to the inflammatory nature of this disease. Additionally, hormonal imbalances play a role in fertility complications. In turn, lack of fertility is associated with chronic inflammation, scarring and adhesions, ovulation and endocrine dysfunction, as well as autoimmunity.

Chronic Inflammation

Endometrial lesions create an inflammatory environment for the affected areas as well as the entire body. This is due mostly to the irritation these lesions cause. Consequently, this irritation causes an inflammatory response in the body. Thus, leading to inflammatory cytokines being released. These cytokines negatively impact the fertilization process. Thus, contributing to issues with embryo implantation as well as oocyte, embryo, sperm and fallopian tube function.

fertility issues

Scarring & Adhesions

The buildup and growth of endometrial lesions can lead to scarring in affected areas. Furthermore, they can cause organs such as the ovaries, fallopian tubes, kidneys, and bladder to adhere to each other. Therefore, impairing function. Additionally, this can contribute to blockages within the fallopian tubes and ovaries. Thereby, leading to further complications with the fertilization process. Furthermore, deep infiltrating lesions and adhesions prevent oocyte and ovum function. In many cases, this leads to the oocyte failing to release from the ovaries. Which in turn impairs the pickup and transport of the ovum.

Ovulation & Endocrine Dysfunction

Ovulation is largely influenced by the secretion of hormones at specific times during the follicular phase. Hormonal imbalances and chronic inflammation can interfere with this process and contribute to a variety of complications that contribute to fertility issues.

Luteinized Unruptured Follicle Syndrome

This issue is caused when follicle fails to rupture and the oocyte isn’t released. Yet, the unruptured follicle still proceeds to go through the luteinization process. Consequently, this is a form of anovulation since an egg wasn’t released from the ovary. Additionally, you may not even realize this is causing fertility issues for you. Since your luteal phase will most likely remain the same and may not display any noticeable changes. But, if you’re tracking your fertility using the symptothermal method you may notice a lack of egg white cervical mucus. Which usually indicates ovulation and peak fertility.

fertility issues

Impaired Folliculogenesis

Folliculogenesis involves the follicles within the ovary maturing. In other words, this process involves the development of the follicle. During this phase, multiple small primordial follicles develop into pre-ovulatory follicles. Consequently, when this process is impaired the ovum isn’t able to form properly. Thus, leading to fertility issues.

Luteal Phase Defect

In the case of a luteal phase defect, the corpus luteum exhibits abnormal function. This can be caused by hormonal imbalances. Specifically, imbalances that impact progesterone levels and cause a decrease in progesterone production.

Premature or Multiple LH Surges

Premature LH surges are mostly talked about in regards to fertility treatments such as IUI (intrauterine insemination)  or IVF (in vitro fertilization). When this occurs during an IUI/IVF cycle there is a rise in progesterone which occurs before a planned hCG trigger. Therefore, compromising the development and maturation of the follicle and egg.

As for multiple LH surges, this happens when follicles are stimulated during the follicular phase. Thus, resulting in the release of a follicle. But, the follicle fails to rupture properly. In turn, the egg fails to release from the ovary.  Once the body realizes this it will attempt to compensate. Hence why over a course of 3-5 days another follicle is released in hopes of achieving ovulation. Oftentimes, this process leads to an anovulatory cycle in which ovulation fails to occur. But, you may still have your period although your ovaries didn’t release an egg. Which leaves you none the wiser that you are experiencing this issue.

fertility issues

Autoimmunity

Finally, let’s discuss the autoimmune connection involved with endometriosis and infertility. Autoimmunity involves the body’s immune system attacking its own healthy cells and tissues. And, there’s been much debate regarding whether endometriosis should be considered an autoimmune disease or not. While this is still an ongoing process a 2008 study explored the possibility of autoimmunity leading to fertility issues for those with endometriosis. The data revealed that 60% of endometriosis patients had autoimmune involvement with their disease. In regards to fertility autoantibodies, IgG and IgM were linked to impairing the proper function of the endometrium. Thereby, interfering with fertilization, implantation, and increasing the risk of miscarriage.

When to Work With A Specialist

A general recommendation for the majority of couples dealing with infertility is that if you’re younger than 35 and you’ve struggled to become pregnant for more than one full calendar year you should seek the help of a fertility specialist. Whereas, if you’re 35 or older and have been unsuccessful at becoming pregnant after 6 months you should make an appointment with a specialist. The role of the specialist is to identify the root cause of your fertility issues and determine what would be best at helping you become pregnant. Upon meeting the doctor you will want to share your full medical history so they can determine the appropriate diagnostic testing. You will also want to ensure that they have some working knowledge of endometriosis and have successfully worked with women that had endometriosis. I’m not saying this is a guarantee that they will be able to help you get pregnant. But, this will ensure that they know exactly how to address your infertility as it pertains to your endometriosis.

 

Additionally, there will be tests administered to both you and your partner. So, you and your spouse should be on the same page in regards to moving forward with this next step. Discussing with your spouse in advance finances, treatments you feel comfortable doing, and treatments you don’t feel comfortable doing is necessary. This will help the process go that much easier for everyone involved.

But There’s Hope

While getting pregnant with endometriosis may involve a few more steps for many women. It isn’t entirely hopeless. Infertility is a common symptom of endometriosis but it doesn’t mean you’re never going to get pregnant. A multitude of options is available to you including intrauterine insemination (IUI) in vitro fertilization (IVF), surrogacy, etc. Discussions with your partner regarding what is best for your family is important. Once you are both on the same page you can then determine the next steps in regards to working with a fertility specialist.

References

1. Natural Fertility Info | The Role of Inflammation in Infertility | written by Hethir Rodriguez Certified Herbalist, Nutritionist, Birth Doula | reviewed by Christine Traxler MD | updated December 4, 2018

2. Medical News Today | What to Know About Endometriosis and Infertility | written by Nicole Galan RN | medically reviewed by Valinda Riggins Nwadike MD, MPH on October 29, 2018

3. J Assist Reprod Genet August 27, 2010 (8): 441-447 | Endometriosis and Infertility | Carlo Bulletti, Maria Elisabetta Coccia, Silvia Battistoni, Andrea Borini

4. Oxford Academic | Human Reproduction Vol 21 Issue 8 pgs 2110-2113 August 2006 | Luteinized Unruptured Follicle Syndrome: Incidence and Recurrence Rate in Infertile Women with Unexplained Infertility Undergoing Intrauterine Insemination | H. Qublan, A. Amarin, M. Nawasreh, F. Diab, S. Malkawi, N.Al-Ahmad, M. Balawheh

5. Reproductive Biomedicine Online Vol 16 No 6 2008 pgs 817-824 | published online April 23, 2008, | Dr. Raul Gajbhiye, A. Suryawanshi, S.Khan, P. Mehriji, N. Warty, V.Raut, N. Chehna, V. Khole

 

About the Author 

women's health and wellness blogger

Hi, my name is Kathleen but you can call me Kat. I’m a health and wellness professional turned freelance writer and content creator.  You can find me on  YouTube and Instagram. If you take the opportunity to visit me on my other platforms don’t hesitate to leave a message, I would love to hear from you!

 

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