Ask our Obstetricians – Endometriosis and infertility with Dr Eva Kretowicz

Starting to try for a baby is an exciting time for most women but if you have struggled with endometriosis in the past you might be concerned that it will affect your fertility. Dr Eva Kretowicz is a consulting obstetrician and gynaecologist at North West Private Hospital and she has taken the time out to discuss this condition, what it means for fertility and what treatments are available.

What is endometriosis?

Endometriosis is one of the most common conditions that affect women in childbearing age. It occurs when cells similar to those that line the inside of the womb, called endometrial cells, are found in other parts of the women’s body. Those cells are most commonly found in the pelvis, near the Fallopian tubes and ovaries, but can grow virtually anywhere, including lungs, brain, large and small intestine and appendix.

How common is it?

Endometriosis affects 10 percent of all women. It is generally more common in women with conditions such as Polycystic Ovarian Disease (PCOS) and fibroids. What’s important when looking at it combined with infertility is that it can be found in up to 50 percent of women with infertility.

What symptoms might you experience if you have endometriosis?

Symptoms vary from woman to woman, and typically include heavy and painful periods, abdominal and pelvic pain, painful intercourse, pain when passing urine or painful bowel motion. A number of women can experience gastrointestinal symptoms, similar to those that occur in patients with Irritable Bowel Syndrome (IBS), such as bloating, diarrhoea and constipation. Typically symptoms appear a few days before menstruation and disappear once the period has finished. Sometimes symptoms can be unrelated to the menstrual cycle. Some women however will have no symptoms other than inability to fall pregnant.

If I’ve struggled to conceive does it mean I definitely have endometriosis?

No, but endometriosis can be found in up to 50 percent of women with infertility so it should be considered in all women with otherwise unexplained infertility, and those women who have failed fertility treatment.

How do you find out if you have endometriosis?

The best way to look for and treat endometriosis is Laparoscopy (keyhole surgery). It will allow your doctor to establish if the disease is mild (minor discoloration of the lining of the pelvis and minor scar tissue) or severe (ovarian cysts, blockages of the Fallopian tubes and scar tissue involving large and small intestine).

Ultrasounds, CT and MRI scans will provide additional information, but are not sufficient to diagnose the disease.

What treatments are available to treat or manage endometriosis and how will that affect fertility?

There are a variety of treatment options available for those women who suffer from endometriosis and are experiencing difficulty conceiving. Women with a mild form of the condition will often benefit from surgical removal of endometriosis, which can be done through keyhole surgery. A number of those women will fall pregnant naturally after they have been treated.

Other women will conceive after milder form of fertility treatment such as intrauterine insemination.

Women who have more severe form of endometriosis might also benefit from surgery, however a large number of those women will require advanced fertility treatment such as in vitro fertilization (IVF) to help them conceive a pregnancy.

It’s important to remember that not all women with endometriosis will be infertile, however it is important to seek advice early if you are suspected to be suffering from the disease or you were diagnosed in the past.