How Does Endometriosis Cause Infertility?

Endometriosis is a medical condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus, typically in the pelvic area, on the ovaries, fallopian tubes, and other structures

In severe endometriosis, infertility is likely due to distortion of the pelvic structure secondary to endometrial lesions, inflammation, and adhesions. In milder diseases, the cause-effect relationship is more controversial. Reduced oocyte viability and/or production as a result of the altered uterine environment may be a contributing factor

Infertility is also a common symptom of endometriosis. Much of the debate has centered on the link between endometriosis and infertility. Detection of endometriosis is higher among women with infertility than normal fertile women undergoing laparoscopy. Endometriosis can induce infertility due to anatomical distortion caused by invasive growth and adhesions. Infertility in patients with endometriosis can be:

caused by the following factors:

• Anatomical distortion caused by the injury

• Altered tubal mobility

• Abnormal tubal epithelium

• Increased prostaglandins and macrophages in the peritoneal fluid

• Increased cell-mediated damage to gametes

• Ovulatory dysfunction

• Unruptured luteinized follicle (LUF) syndrome

Endometriosis can also cause the following symptoms:

• Chronic pelvic pain

• Cyclic or perimenstrual symptoms affecting the bladder. or bowel ( with or without abnormal bleeding or pain)

• Chronic fatigue

• Dyschezia (painful bowel movements)

Pain related to endometriosis should be relieved within 2 months of starting medical treatment. If symptoms persist, a different medical and/or surgical therapy should be considered. For endometriosis-related infertility, most experts recommend 6 months of watchful waiting after surgery. If pregnancy is not achieved by this time, assisted reproductive techniques may be considered

Medical Treatment of Endometriosis-Associated Infertility Most of the established medical therapies used to treat endometriosis have been applied to the problem of subfertility in women with endometriosis. These drugs inhibit ovulation and are therefore used to treat the condition for a period of time before allowing an attempt to conceive. Five randomized trials with six treatment arms compared one of these endometriosis-targeted medical treatments with placebo or no treatment with fertility as an outcome measure96-100. Eight other randomized clinical trials (RCTs) compared danazol with a second drug

The latter studies were recently summarized in a meta-analysis by Hughes et al. Clearly, no increase in fertility can be demonstrated with these drugs compared to expectant management; nor has any drug proven superior to danazol in this regard. But wait! While some studies were placebo-controlled, others simply compared medications with no treatment 

For the latter study design, patient follow-up began at the end of therapy; therefore, those who did not receive treatment began trying to conceive immediately after the diagnostic laparoscopy, while those who received drug therapy were not allowed to try to conceive until after the course of drugs was completed (usually 6 months). These studies were analyzed as if time began at the end of “treatment,” but for the patient the clock starts ticking at the time of

It's important to note that not all women with endometriosis will experience infertility, and the degree of infertility can vary. Some women with mild endometriosis might conceive without difficulty, while others with more severe cases might struggle to conceive. If a woman with endometriosis is having trouble getting pregnant, it's recommended to seek guidance from a fertility specialist or reproductive endocrinologist. There are various fertility treatments available that can help improve the chances of conception for women with endometriosis, such as hormonal therapies, surgical interventions to remove adhesions, and assisted reproductive technologies like in vitro fertilization (IVF).