Endometriosis Related Infertility & Pregnancy

If you have endometriosis you have probably already asked your doctor; "How will this affect me getting pregnant?"  Many women with mild to moderate endometriosis can, and do, go on to conceive a child naturally without fertility treatment.  The latest studies are showing that about 21 to 44 percent of infertile women have endometriosis compared to only 4 to 22 percent of fertile women.  In addition, women with endometriosis are 50 to 80 percent more likely to suffer from infertility.  If they are fortunate enough to get pregnant they are also more likely to suffer miscarriages, and they have an increased risk for premature birth, malpresentation, caesarian section, placenta percrata and placenta previa.

Endometriosis is closely linked to infertility.  Inflammation caused by the endometriosis lesion is the main culprit for the infertility. Primarily, the peritoneum is always affected by the disease  and so are the ovaries, with subsequent development of scar tissue causing anatomical distortions.  In addition to these anatomical distortions, inflammatory chemicals, elevated cytokines, and alterations in prostaglandin secretion all can contribute to the inability of the sperm and egg to attract each other.  Finally, in the case of pregnancy, the body's own impaired immune response can result in rejection of the early implanted embryo.

The question you now ask yourself; "Should I have surgery to correct my endometriosis before IVF treatment?"  The answer is a controversial one based on what stage of endometriosis you have and is recommended on a case-by-case basis.   Dr. Seckin recommends that patients that have debilitating symptoms of endometriosis and whose quality of life is severely impacted have surgical intervention. The excisional surgery, which is the "gold standard" for removal of the affected tissues, is most effective in making sure  that  no disease is left behind.  This increases the likelihood of conceiving and carrying a pregnancy to full term in all stages, particularly, in the advanced stages of endometriosis.  Dr. Seckin also recommends consulting with an IVF specialist prior to any endometriosis surgery.

Prior to IVF treatment, your reproductive specialist may recommend surgical removal of your endometriosis to enhance the chances for a successful IVF outcome, and to decrease infectious complications related to egg collection.  The knowledge and experience of your reproductive specialist is imperative to successful IVF treatment.  Not all IVF specialists recognize the impact of endometriosis on infertility or look as closely at the immune component on miscarriages as Dr. Jeffrey Braverman of Braverman IVF & Reproductive Immunology.  Dr. Seckin recognizes Dr. Braverman as the only specialist who performs extensive blood tests in search of the inflammatory and immune component of infertility and miscarriages due to endometriosis.  

If surgery is done by laser and/or cauterization, due to the high incidence of residual tissue left behind, there is a higher incidence of inflammation and production of cytokines that can lead to an unfavorable implantation process and to miscarriage.   These cytokines are produced when the immune systems swoops in to repair a problem like endometriosis.  While the excision surgery greatly improves the outcome, many patients who have gone on to become pregnant and yet miscarry, or those who fail to conceive at all, should arrange for a reproductive immune profile.

If you have any of the symptoms of endometriosis and you have been trying unsuccessfully for six months to get pregnant, then you need to see a reproductive specialist.  The excision of the inflammatory tissues will improve your IVF outcome.