How to deal with endometriosis to preserve fertility

HOW TO DEAL WITH ENDOMETRIOSIS TO PRESERVE FERTILITY

Endometriosis is a common and long-term condition which affects 1 in 10 women in the UK. It occurs when the lining of the uterus (endometrium) grows in other places, such as the fallopian tubes, ovaries or along the pelvis. The condition causes heavy and painful periods as well as pain in the lower abdomen, pelvis, or lower back.

Around 30% of women with endometriosis have fertility problems, this can be as a result of scarring on the tubes and ovaries, issues with the quality of the egg or problems caused by the embryo travelling down the tube and implanting in the wall of the uterus.

With diagnosis for endometriosis taking an average of 7.5 years in the UK, Endometriosis Awareness Week (3^rd – 11^th March) is aiming to raise awareness of the signs and symptoms of the condition for women who may not yet have a diagnosis.

Mr Anthony Rutherford, Consultant Gynaecologist in reproductive medicine and surgery at Leeds Centre for Reproductive Medicine, gives his advice on how to deal and treat endometriosis in order to preserve fertility, ahead of his seminar at The Fertility Show.

1. Act on your symptoms – It is very important that women are aware of the symptoms of endometriosis as you may not discover you have the disease until you are actively trying for a baby. If you have a history of painful periods, including pain before you start your period as well as during, and have experienced pain during sex then I would advise speaking to your doctor. Early referrals for women with endometriosis are vital as surgical treatment in most circumstances would improve your outcome of natural conception in the future. In the biggest surgical study conducted in women with endometriosis, patients who had treatment for the disease compared to those that didn’t were assessed across a 9-month period post treatment. The results showed a 17% chance of natural conception if women had no treatment and a 30% chance if they had treatment.
2. Endometriosis doesn’t stop conception – Women with endometriosis can get pregnant naturally but have about half the chance of getting pregnant compared to their peers of a similar age. If you have been diagnosed I would recommend asking your doctor about your options as each case needs to be treated individually. This could involve trying to conceive naturally for 6 months or surgery to aid conception. If you have been trying for 2-3 years then you should explore alternative methods such as IVF as this would improve the chances of conceiving.
3. Don’t rush into invasive surgery if you are trying to conceive as it could delay conception –If you are diagnosed with endometriosis while trying to conceive, medical management of the condition involves supressing ovulation, which of course will stop you getting pregnant. There is no evidence that treating endometriosis before IVF would improve the outcome. I think that a lot of patients might benefit from not having to go through difficult and stressful surgery at a time when they are trying to conceive. Ultimately, having surgical treatment when you are already struggling with conception delays the fertility treatment itself and further delays the pregnancy. The other consideration about operating on an endometrioma is that while an ovarian cyst may be removed part of the normal functioning ovarian tissue may also be removed and that would mean a woman’s ovarian reserve would be reduced on that side.