There are many components to fertility that women might encounter with endometriosis. Some of these problems can be corrected by careful surgery.
These problems can be classified as ovarian (ovulation), tubal (infection, damage), uterine (polyps, fibroids) or inflammatory (endometriosis).
Endometrial polyps and submucosal fibroids (on the inside of the uterine wall) are examples where simple surgery can dramatically improve natural fertility.
Occasionally more complex surgery is necessary to improve fertility, particularly in the presence of pelvic endometriosis (see table below summarising a woman’s fertility rate). The effect of adding an inflammatory but eminently treatable condition such as endometriosis is dramatic.
Fortunately, careful excisional surgery – a hallmark of surgery under the care of Dr Simon Gordon – can easily return a women’s fertility to that of an age-matched woman with an otherwise normal pelvis.
How Endometriosis affects fertility
Endometriosis can affect fertility in a number of ways:
- By creating a “hostile” environment in the pelvis, with inflammatory cells preventing embryo implantation even if the embryo is installed via IVF
- By damaging the tubal fimbria which allow the eggs to be transferred into the uterus for fertilization
- By adhesions which obstruct the fallopian tube
- By ovarian entrapment
Save the cases where there is complete obliteration of the pelvis, the most common cause of infertility is due to the hostile environment.
By removing all active endometriosis, once new peritoneum has formed in the weeks after surgery natural fertility can occur. This has been evidenced in hundreds of patients over the last 21 years as a specialist endometriosis surgeon.
How to increase fertility when suffering from endometriosis
A patient suffering from endometriosis will have a significant improvement in natural fertility by having all endometriosis lesions and associated scar tissue excised.
Patients with a “hydrosalpinx” (damages, swollen tube often seen after pelvic infection) will have their fertility improved by having the diseased fallopian tube removed. So long as the other tube is unaffected and proven patent, then natural conception will still happen.
Patients with “entrapped ovaries” or a “frozen pelvis” will have severe pain and little chance of conceiving until the pelvic anatomy is normalised.
Patients with deep infiltrating endometriosis (DIE) in an obliterated pelvis will not be able to proceed to IVF until the pelvic anatomy is corrected. The risk of rectal perforation and abscess formation is too high until surgical correction has occurred.
Fertility rates with endometriosis
One of the real challenges for women is the fact that egg quality deteriorates with age. This decline in fertility is increased dramatically for women suffering from endometriosis.
Over the last 20 years, Dr Gordon has had the pleasure of seeing many patients with severe bowel endometriosis conceive naturally once appropriate surgery has occurred.
|Age vs fertility % per cycle||Normal pelvis||With endometriosis|