The good news first: Fortunately, about half of all patients with endometriosis have no problems whatsoever with conception, pregnancy and childbirth. However, in some cases, endometriosis can unfortunately make things difficult.
When can endometriosis affect fertility?
Sometimes, the location of endometriomas is problematic. If they are located on ovaries or fallopian tubes, they may interfere with normal physiological function. When endometriomas are located in the uterine muscles, they may impede implantation and development of the embryo, increasing risk of miscarriage. Therefore, healthcare providers will want to check on fallopian tubes – are they obstructed, are there endometriomas? If adhesions are a likely reason for difficulties conceiving, they will be loosened as far as possible and endometriomas surgically removed.
This significantly increases the chances of pregnancy. But: Even if the operation was successful, some women may still not get pregnant. Reasons for this are, among other things, inflammatory processes associated with endometriosis, hormonal changes such as estrogen dominance and increased oxidative stress.
Hormonal changes in endometriosis
Endometriosis patients often experience an imbalance of their hormonal system. Too much estrogen and too little progesterone is a classic. Endometriosis patients may also have progesterone resistance, which means that the sex hormone cannot fully develop its effects, even though it is present in sufficient quantities. Unfortunately, too much estrogen and too little progesterone promote inflammation and the development of further lesions. This creates a vicious circle in which the estrogen dominance caused by the endometriosis favors the further progression of the endometriosis.
Estrogen also has a regulating effect on other hormone cycles that are important for female fertility. Therefore, many women with endometriosis also have altered levels of LH (luteinizing hormone). This can affect follicle growth, ovulation, and the development of the corpus luteum in the ovary. Impaired folliculogenesis in women with endometriosis is visible by a reduction in the number of preovulatory follicles, follicle growth, dominant follicle size, and follicular estradiol concentrations.
Inflammation, oxidative stress and fertility
Another major problem for patients with endometriosis is inflammation. It leads to greatly increased oxidative stress. The problem: Oxidative stress may significantly damage oocyte quality, so that women with endometriosis may not only have fewer oocytes, but their quality may be impaired as well.
In addition, increased oxidative stress also has an impact on the partner’s sperms. It hampers their motility, they get more likely to be attacked by the partner’s immune system, make less progress in general and binding to the oocyte is not easy either.
Finally, inflammation and oxidative stress even affect the genetic health of ova and sperm: Peritoneal fluid from women with endometriosis has been shown to increase the amount of DNA fragmentation in sperms from healthy donors.
Good to know: Fertility treatment offers very good prospects of success.
The patient herself can support success of treatment by protecting oocytes from inflammation and increased oxidative stress. Experts advise to stick to an anti-inflammatory diet and consume plenty of antioxidants.
Endometriosis and pregnancy
Studies show that pregnant women with endometriosis can have a pregnancy just as uncomplicated as any other woman. During pregnancy, they are usually spared from endometriosis symptoms and sometimes the improvement continues even after pregnancy.
There is no evidence that endometriosis may adversely affect the course of the pregnancy or the health of the baby. The babies of endometriosis patients are always a little smaller than children of non-endometriosis patients, but not to an extent that would give cause for concern. However, risk of high blood pressure and risk of so-called placenta previa is slightly increased during pregnancy. This is when the placenta is directly in front of or at the edge of the cervix. It requires closer monitoring of the pregnancy and – depending on the exact location of the placenta – delivery by caesarean section.
Speaking of childbirth: In the past, people sometimes worried about natural delivery after an endometriosis operation. There were concerns that vaginal tears or birth complications could occur more often. Today we know that women with endometriosis give birth just as often spontaneously as other women and without any tendency towards increased complications for mother and child. Women with endometriosis may however have slightly higher loss of blood during childbirth.
Sometimes, after giving birth, endometriosis patients may benefit from a multivitamin with iron and a number of other vitamins and minerals that are needed in larger amounts after childbirth and while breastfeeding. 😊
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