Endometriosis and Fertility
Diagnosis and Stages
Endometriosis can be found in up to 70% of unexplained infertility patients who do not have any pelvic pain symptoms and affects 1 in 10 women in the United States. Among women who have symptoms, the most common are pelvic pain and difficulty getting pregnant. The National Institutes of Health (NIH) estimates that about 75% of all women with pelvic pain have endometriosis.
Endometriosis is classified into one of four stages (I-minimal, II-mild, III-moderate, and IV-severe) depending on location, extent and depth of endometriosis implants, presence of severity of adhesions and presence and size of ovarian endometriomas. The stage of endometriosis does not correlate with the presence or severity of symptoms.
Most women have minimal or mild endometriosis (stage I to II), which is characterized by superficial implants and mild adhesions. Moderate and severe endometriosis (stage III to IV), is characterized by chocolate cysts and more severe adhesions. Infertility is very likely for patients with stage IV endometriosis.
Treatment & Success
The condition is usually diagnosed through laparoscopic excision surgery. During a laparoscopy, the entire lesion is carefully removed including the tissue beneath the surface. Excision surgery removes the disease both above and below the surface. An alternative treatment method to the above may be an ablation or cauterization surgery.
Ablation or cauterization surgery only removes the tissue on the surface but neglects the tissue growing beneath it. In most cases, ablation/cauterization surgery will not be effective for long-term management of endometriosis because the tissue remains below the surface. Excess scar tissue can also form using these methods causing inflammation and pain.
Additional ways to manage endometriosis and increase a woman’s chance of conception is through the use of fertility medications such as Clomid or Femara (with IUI or IVF). Patients with stage I to II endometriosis react well to Clomid or Femara cycles with IUI and increase fertility by about 11%*. Whereas for patients with stage III to IV endometriosis there is a less than 5 % a month success rate when using Clomid or Femara with IUI. Therefore it is more cost effective for stage III to IV endometriosis patients to go straight to IVF. According to Dr. Samuel E. Brown, “Patients under the age of 35 with stage III to IV endometriosis have approximately an 80% pregnancy success rate with IVF when transferring 1 embryo; compared to the national average of 50% when transferring 2 embryos”. Untreated mild endometriosis patients conceive on their own at a rate of 2% to 4.5% per month, compared to a 15% to 20% monthly fertility rate in normal couples.
Moderate and severe endometriosis patients have monthly pregnancy rates of less than 2%. Even though endometriosis is associated strongly with infertility, not all women who have endometriosis are infertile and although there is no cure for endometriosis, the prognosis is favorable. With the proper care and treatment many women suffering can carry babies to full term.