For women who are currently trying to conceive or want to get pregnant with endometriosis, it is best to go directly to IVF. Artificial insemination is generally not comprehensive enough, and IVF bypasses the fallopian tubes, which are a known target of endometriosis and its effect on fertility potential.
What endometriosis is
Endometriosis is a disease that has plagued women for centuries. Women with endometriosis have tissue that would normally line the inside of their uterus, but instead lines the outside of the uterus. The problem is that this tissue is not in its normal place. It can scar tubes, ovaries, and other pelvic organs, leading to symptoms of severe menstrual cramps, daily pelvic pain, pain during sexual intercourse, and conception delay. It is even associated with a mild increase in miscarriages.
Endometriosis can only be diagnosed visually by observation in situ. Biopsies of implants can confirm the tissue as being similar to that found in the lining of the uterus.
Symptoms that often go unrecognised
Because symptoms of the condition are similar to those of severe PMS, many women — and their providers — may not be aware that endometriosis is present. Typical symptoms include very painful menstrual cramps (dysmenorrhea), abnormal or heavy menstrual bleeding, and painful intercourse (dyspareunia). Since many women believe they simply suffer from severe PMS, it is common for those with endometriosis not to discuss their symptoms with their doctor, or for doctors to assume that PMS alone is to blame. For a majority of endometriosis sufferers, a diagnosis may be even more difficult to come by since their only symptom may be infertility, which is only discovered after unsuccessful attempts to conceive without fertility testing and diagnosis.
How endometriosis affects fertility
For an estimated 30–50% of women with endometriosis, the condition can result in an infertility diagnosis. Because of the presence of the outer uterine tissue, infertility can occur due to a few different factors, including pelvic inflammation, scarring and adhesions from tissue, impaired implantation of an egg, lowered egg quality and distorted pelvic anatomy. One or more of these factors can affect a woman's ability to conceive. Advanced endometriosis is one of the situations in which IVF may be recommended immediately as a first step in treatment, rather than after other treatments have been tried.
Our approach: IVF first
IVF makes it possible for the embryos to be tested for chromosomal integrity before transfer, eliminating other confounding issues that would disrupt pregnancy. The inflammation of endometriosis can be dampened using steroids and baby aspirin to augment possible implantation woes. IVF also bypasses the need for fallopian tubes in the process of conceiving.
In uncommon cases, one has to pre-treat to eradicate the endometriosis in part before the IVF attempt. At Chelsea Fertility NYC, this is not our recommendation as a first-line approach. It delays the first attempt, which can work, and recovery can be long. Aggressive surgery can also damage the blood supply to the female organs and lead to even more conception problems. So it is not considered a first step in our clinic. Our physicians bring 80 years of combined experience to these cases and have several strategies that have worked.
To learn more about fertility treatment for women with endometriosis, please contact the fertility specialists at Chelsea Fertility NYC.