Endometriosis and fertility: the statistics that may surprise you

It’s endometriosis awareness month

Endometriosis is, unfortunately, a common gynaecological problem.

It can cause crippling pain or no pain at all.

The severity of endometriosis can impact on your ability to conceive naturally. According to the National Endometriosis Society in the United Kingdom the chance of conceiving if you have mild to minimal endometriosis is not that different to a woman without endometriosis. The greater the severity of your endometriosis however the lower the chance you have of conceiving naturally.

As we’ve said in a previous blog, there is—as yet—no known cure for endometriosis. A common myth is that pregnancy will cure endometriosis, while this is untrue it has stemmed from the fact that pregnancy can supresses endometriosis symptoms. Once you’ve stopped breast feeding the symptoms will return.

The “Endometriosis, Fertility and Pregnancy” leaflet put out by Endometriosis UK states:

  • If 100 women without endometriosis try for a baby at the end of the year 84 will be pregnant.
  • If 100 women with minimal-mild endometriosis try for a baby at the end of the year 75 will be pregnant.
  • If 100 women with moderate endometriosis all start trying for a baby at the end of year 50 will be pregnant.
  • If 100 women with severe endometriosis start trying for a baby, at the end of the year 25 will be pregnant.

Endometriosis and infertility?

There are four stages to endometriosis:

  1. Stage i (minimal)

This stage is characterised by a superficial lesions and a few filmy adhesions.

2. Stage ii (mild)

In addition to the above, there are also some deep lesions present.

3. Stage iii (moderate)

Same as stage ii, with the addition of endometriomas on the ovary and extensive adhesions.

4. Stage iV (severe)

Same as stage iii, plus large endometriomas, extensive adhesion and nodular disease.

How endometriosis can cause infertility

Scar tissue distorts the pelvic anatomy, and if the ovary is wrapped in adhesions the egg gets trapped and is unable to reach the tube.  If the Pouch of Douglas is covered in adhesions then the chance of fertility is also lower.

There are a few theories as to why mild to minimal endometriosis causes infertility:

  • An abnormal immune response
  • Failure of the egg sac to release its egg
  • Toxins in peritoneal fluid (a naturally occurring fluid within the body cavity)
  • Problems with the egg transport down the fallopian tube

Pregnancy and endometriosis

Endometriosis can delay getting pregnant however once you are pregnant it should not be any different than normal.  What normally happens is that from pregnancy through to breast feeding the symptoms of endometriosis are supressed, which is where the myth that endometriosis can be cured by pregnancy comes from.

One of the biggest problems with endometriosis (as with many chronic, currently-incurable illnesses) is the emotional effects. Imagine being in too much pain to get out of bed. Essentially, the emotional effects of this can be just as crippling as the physical.

March is endometriosis awareness month

This chronic illness affects, on average, one in ten women. And on average, it takes eight years from presenting symptoms to diagnosis.

There needs to be more awareness about the symptoms of endometriosis. Ultrasound clinics like OMNI Ultrasound & Gynaecological have the diagnostic tools to diagnose endometriosis, but GPs and Obstetricians need to be cognisant of the symptoms of endometriosis so they can send women to get the tests they need.

Although no one knows the natural history of the disease, if endometriosis is not treated it can potentially worsen over time.

To find out more about OMNI Ultrasound & Gynaecological Care can help you, or to book a consultation at one of our Sydney clinics, please contact us.

Book a consultation

OMNI Ultrasound & Gynaecological Care

Condous performs Advanced Endosurgery procedures for women needing intervention for pelvic masses, adnexal pathology, severe endometriosis or hysterectomy. He also runs ‘Hands on’ Live Sheep Laparoscopic Workshops for gynaecologists at Camden Veterinarian School.
Having completed an undergraduate degree with the University of Adelaide, he left Australia in 1993 and moved to London where he completed his training in Obstetrics and Gynaecology. From 2001 to 2003 Condous worked as a Senior Research Fellow at St George’s Hospital, London. At St George’s he set up the Acute Gynaecology Unit, the first in the United Kingdom. It was also during this time that he developed an interest in Early Pregnancy and especially the management of pregnancies of unknown location (PULs). Condous has developed many mathematical models for the prediction of outcome of PULs which have been featured in numerous peer review journals. In 2005, he returned to Australia where he completed his Laparoscopic Fellowship at the Centre for Advanced Reproductive Endosurgery, Royal North Shore, Sydney.

Condous was appointed as a Consultant Gynaecologist and Senior Lecturer at Nepean Hospital in 2006 and soon was made Associate Professor. In 2010, he was made Departmental Head of Obstetrics and Gynaecology at Nepean Hospital. He obtained the MRCOG in 1999 and was made FRANZCOG in 2005. In 2009, he was awarded his Doctorate in Medicine (MD), University of London, for his thesis entitled: “The management of pregnancies of unknown location and the development of new mathematical models to predict outcome”.

Condous has edited three books including the “Handbook of Early Pregnancy Care”, published over 100 papers in international journals and is internationally renowned for his work in Early Pregnancy. He is the Associate Editor for Gynaecologic Obstetric Investigation, which is a European based journal, as well as the Australasian Journal of Ultrasound in Medicine (AJUM). He is on the organising committee and is an invited speaker at the International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG) Scientific meeting in Sydney 2013. His current research interests relate to the management of ectopic pregnancy, 1st trimester growth, PULs and miscarriage and the use of transvaginal ultrasound (in particular sonovaginography, to predict posterior compartment deep infiltrating rectovaginal endometriosis).Condous is also actively involved with post-graduate education including the annual running of the Early Pregnancy and Gynaecological Ultrasound Interactive Courses for Sonologists, Radiologists, Sonographers and Gynaecologists in Australia.