Endometriosis And Fertility in Singapore

about Endometriosis and Fertility

What is the prevalence of endometriosis affecting fertility?

Endometriosis is a chronic gynaecological condition characterised by the abnormal growth of endometrial tissue outside the uterus. As endometriosis progresses, abnormal tissues, cysts, lesions and adhesions can be found on reproductive organs such as the ovaries, fallopian tubes and supportive ligaments of the uterus. Endometriosis subsequently interferes with the ovulation, fertilisation and implantation process of the embryo– significantly impacting the ability to conceive naturally.

These statistics highlight the prevalence of infertility among women with endometriosis;

As 20-25% of endometriosis patients are asymptomatic (also known as silent endometriosis), some women tend to uncover their diagnosis when investigating their inability to conceive.
It is estimated that 25 to 50% of infertile women have endometriosis while 30 to 50% of women with endometriosis are infertile.

diagnosed

How does endometriosis affect fertility?

There are multiple possibilities as to how endometriosis can impede fertility. The following table summarizes how endometriosis can hinder fertility through different pathways;

Factors	Impact of endometriosis on fertility
Anatomical changes	Endometrial adhesions and scarring can distort the pelvic anatomy. These adhesions and scarring can result in the uterus tilting to one side, or causing adhesions around ovaries and tubes . Distorted anatomy subsequently interferes with mechanisms of ovum pickup, oocyte fertilization, and tubal transport.
Immune dysfunction	Endometriosis is a chronic inflammatory disease that can affect, and even alter the immune system. The presence of endometriosis triggers the alteration of the peripheral immune system, as well as the immune level of the endometrium within the uterine cavity. These changes result in infertility and even miscarriages.
Reduced egg quality	One of the known complications of endometriosis is abnormal follicle growth– women with endometriosis have higher amounts of reactive oxygen species (ROS) in their follicular fluid. As a result, ROS can cause ovarian eggs to mature improperly, deteriorating the egg quality, and reducing the chances of successful fertilisation, and implantation.

An overview of factors associated with reduced fertility in women with endometriosis

What are the possibilities of reversing the damages caused by endometriosis to improve fertility?

Although infertility is frequently mentioned alongside endometriosis, it is crucial to remember that infertility is a potential outcome, not an inevitable one. Whilst conceiving naturally with endometriosis could be statistically unfavourable, there are an array of treatment options that can improve your chances of becoming pregnant. Nevertheless, an early diagnosis is still a key factor in preserving fertility among patients with endometriosis.

As endometriosis is a complex condition to diagnose, it leads to the possibility of endometriosis progressing to advanced stages as time passes by. Additionally, deep infiltrating endometriosis may cause damage to the reproductive organ, which further reduces your fertility rate along with your chances of becoming pregnant.

Severe pelvic pain during menstruation is one of the primary symptoms of deep infiltrating endometriosis.

What are the chances of becoming pregnant even with endometriosis?

Research has thus far indicated that the higher the stage, the less of a chance of conceiving naturally exists. Below are the accumulated hypotheses drawn from different studies;

Patients with stages I and II of endometriosis had a 60% chance of conceiving without surgical treatment. The chances of conceiving after endometrial excision (link to endometrial excision page) are between 80-85% – akin to women without endometriosis.
Patients with stage III endometriosis had a 15-20% chance of conceiving without surgical treatment. This probability is dramatically improved at a 70-75% chance of conceiving following surgical treatment.
Patients with stage IV endometriosis can increase conception probability up to 50-60% with surgical intervention.

If pregnancy has yet to occur within 6 months post-treatment for endometriosis, your healthcare provider will propose other fertility treatments to help increase the possibility of you conceiving.

infertility

What are the treatment options for endometriosis-related infertility?

At Dr Ma Li Clinic For Women & Advanced Pelvic Surgery treatment process typically begins by performing a thorough fertility assessment, which may include blood tests and hormone tests, ultrasound scan test, fallopian tube test, and sperm test.

Once a comprehensive detail of your condition and fertility rate has been gauged, a personalised treatment plan is formulated to help improve your chances, whether through surgery first or through fertility treatment first.

Surgical intervention: the purpose of the surgery is to remove endometriosis tissue, separate adhesion, and remove endometriotic cysts to help improve the fertility rate, thereby increasing your chances of becoming pregnant. Surgical management would be recommended if;
-if you experience worsening pain which is not helped by medicine
-a big ovarian cyst that may affect oocyte pick-up
-position of the ovary is too high for oocyte pickup due to dense pelvic adhesion
-hydrosalpinx (fluid accumulation in fallopian tubes, creating a blockage)
Elective egg freezing: as endometriosis affects the ovarian reserve, preserving your eggs will also preserve your hope of becoming pregnant in the future, while you undergo treatment for endometriosis.
Superovulation, and Intrauterine Insemination (SO-IUI): SO-IUI is a non-invasive fertility treatment that involves using fertility medications to stimulate the ovary to produce 1 to 2 eggs within a cycle. However, this treatment is only suitable for women with mild endometriosis.

Severe pelvic pain during menstruation is one of the primary symptoms of deep infiltrating endometriosis.

How does IVF help women with endometriosis?

It is important to understand that fertility treatments do not cure endometriosis. When it comes to treating endometriosis-related fertility issues, the goal is to improve your chances of getting pregnant. One of the best treatments for women with endometriosis-related infertility is in vitro fertilization (IVF).

IVF is an assisted reproductive treatment that bypasses a handful of endometriosis-related complications, including anatomical distortions.

Before IVF is recommended, there are certain factors will be taken into consideration to determine the IVF success rate, which include:

Age: fertility naturally declines with age due to reduced egg quantity, and quality. With endometriosis, the condition speeds up the process. While IVF is suitable for women of any age, the success rates of a successful pregnancy through IVF are higher among women below the age of 40.
Stage of endometriosis: the IVF success rate for stage 3, and 4 endometriosis is lower compared to stages 1, and 2. However, this will depend heavily on how advanced, or progressive your endometriosis is and the location of endometriosis. If you suffer from severe pain due to endometriosis, or advanced endometriosis, you may be advised to undergo surgery first to help increase the IVF success rate.
Ovarian reserve: before IVF treatment an ovarian reserve test will be conducted to determine your egg quantity.

If you are experiencing possible symptoms of endometriosis, or have had difficulties conceiving, schedule a consultation to have your symptoms examined.

FAQs

Frequently asked questions

Does endometriosis always lead to infertility?

No, endometriosis does not always result in infertility. Depending on the stage of endometriosis, it affects your fertility rate and chances of becoming pregnant in various extent.

Am I considered high risk if I get pregnant with endometriosis?

Yes, you are considered to be in a high-risk pregnancy because the presence of endometriosis especially adenomyosis can increase the chances of miscarriage , preterm labour, placenta abnormality, intra-uterine growth restriction, pre-eclampsia etc. The importance of obtaining early diagnosis is further reinstated to help ensure a safe delivery.

Is it possible for endometriosis to recur after pregnancy?

Some women have found that their endometriosis-related symptoms improve throughout pregnancy, and breastfeeding due to the shift in hormones. However, these symptoms often return as the woman phases out of pregnancy, and breastfeeding.

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