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Does Endometriosis Cause Infertility?

15 worried woman talking to a doctor

Endometriosis can lead to multiple health complications. Regardless of its severity, it is almost always associated with a reproductive dysfunction manifesting as either infertility or early pregnancy loss. The condition reduces the ability to conceive even in its mildest and earliest stages of development.

Endometriosis can influence fertility in a variety of ways, including:

  • Distorted anatomy of the pelvis
  • Scarred fallopian tubes
  • Inflammation of the pelvic structures
  • Altered immune system functioning
  • Changes in the hormonal environment of the eggs; impaired implantation of a pregnancy
  • Altered egg quality

Approximately one-third to one-half of all women with endometriosis has difficulty getting pregnant. But infertility is not always certain. The condition affects each patient differently, from the severity of pain and discomfort to the overall effect on fertility.

Most Cases of Endometriosis Are Mild

When you’re being diagnosed or treated for endometriosis, your doctor will evaluate the amount, location and depth of the growths to determine whether your endometriosis is considered minimal (stage 1), mild (stage 2), moderate (stage 3) or severe (stage 4).

This scoring system correlates with the extent that the condition might influence the success of pregnancy. Women with severe endometriosis will have considerable scarring, damaged ovaries and blocked fallopian tubes. They will also require advanced treatment.

Luckily this is quite rare, with most patients having mild endometriosis. A cause and effect relationship between mild endometriosis and infertility has not been proven and is the subject of much debate in medical circles.

It might be that infertility predisposes women to develop endometriosis, rather than the endometriosis causing infertility. In this case, experts would consider infertility associated with mild endometriosis to be “unexplained” infertility.

How Might Endometriosis Affect Fertility?

There are a number of explanations concerning how endometriosis can create an environment that compromises the fertilisation process. For pregnancy to occur, an egg must be released from an ovary and travel through the fallopian tube to become fertilised by a sperm cell. It then attaches itself to the uterine wall to begin development.

Endometriosis can obstruct the tube if the endometrium (lining of the uterus) grows on the fallopian tube or uterus, preventing the egg and sperm from uniting. The condition can also affect fertility in less-direct ways, such as damaging the egg or sperm.

This includes the presence of cysts, which, like other space-occupying lesions in the ovary, can activate connective tissue in the ovary. This causes excessive production of male hormones (predominantly testosterone), which can compromise egg/embryo quality and development.

About a third of women with endometriosis have activated uterine natural killer cells. Although it hasn’t been entirely proven, some experts suggest these cells can identify developing cells/embryos as foreign and attack them, preventing a successful pregnancy.

Treating and Preventing Complications from Endometriosis

Keep in mind that many women with mild to moderate endometriosis can still conceive and successfully carry a pregnancy. Some doctors will advise women with endometriosis not to delay having children as the condition can worsen over time.

Alternatively, you can freeze your eggs to ensure the condition doesn’t affect your chances later down the track. For patients who wish to become pregnant, there are also multiple treatment options, including oestrogen blocking/lowering drugs and laparoscopic surgery.

Dr Alex Polyakov is a skilled physician in Melbourne with extensive experience helping people with IVF, pregnancy, fertility and endometriosis. If you are experiencing symptoms of endometriosis or would like more information about how it affects fertility, contact our clinic.