As we mark Endometriosis Awareness Month, we ask Repromed Fertility Specialist, endometriosis expert and Gynaecologist Prof Neil Johnson common FAQs about endometriosis and how it may impact your fertility.
How does endometriosis affect fertility?
Endometriosis is a disease where endometrial type tissue with fibrosis and scarring occurs outside of the uterus. There are several ways in which endometriosis can affect fertility.
It can distort the relationship between the fallopian tubes and ovaries, and it can damage and block fallopian tubes. The ovarian reserve can be affected, and egg quality may also be affected, as well as the ‘peritoneal environment’ – the area where eggs have to pass between the ovary and the fallopian tube.
As well as being a disease outside of the uterus, the uterus itself is recognised as being affected. There is also some evidence that endometriosis affects fallopian tubes.
If you have endometriosis then you may know that its association with persistent pain can make having sex uncomfortable, particularly at the key ovulation phase of the cycle – and persistent pain can also in turn have its own psychological impacts.
Do I need IVF if I have endometriosis?
Not necessarily. IVF is an option if you have endometriosis and have identified fertility issues but there are alternatives.
What is the best fertility treatment for those with endometriosis?
There isn’t a ‘one size fits all’ approach to treatment. At Repromed we like to offer a broad, holistic approach. This means that we provide a range of treatment options and a treatment plan that is personalised to meet your needs.
For those with no damage to the fallopian tubes, I am an advocate of starting with Lipiodol HSG (hysterosalpingogram), a simple tubal flushing procedure that bathes the uterus in lipiodol (poppy seed oil). We use a technique where a fine catheter is introduced through the cervix and the lipiodol is gently instilled into the uterus and fallopian tubes. (Learn more about Lipiodol here.)
Lipiodol can be used to promote conceiving naturally (increasing the chances fourfold) or in combination with Intrauterine Insemination (IUI) which can triple the chance of conception and is a good starting point if you have been recommended fertility treatment, as it’s more affordable and less invasive than IVF. (You can learn more about IUI here.)
Many of my patients have had success with a Lipiodol procedure then alternating natural cycle attempts to conceive naturally, and adding in IUI treatment, which helps boost fertility further.
Laparoscopic surgery can also be helpful. It doesn’t solve it for everyone but the evidence suggests that surgery works and there will be some people that need surgery in order to get pregnant. But as mentioned before, some people might also fall pregnant naturally without having their endometriosis removed.
What are the success rates?
Endometriosis doesn’t have a negative impact on the chance of success with IVF as the process of IVF gets around most issues.
Lipiodol bathing/flushing is an effective treatment. Research in 2004 revealed a significant increase in pregnancy and live birth for people with endometriosis (and particularly effective for those with normal fallopian tubes and ovaries.)
It’s important to note that many people with endometriosis can get pregnant naturally however, even for those with minimal or mild endometriosis, it still on average takes twice as long to get pregnant.
Do you have any lifestyle advice, such as a diet, that can help boost my fertility?
There isn’t an ‘endometriosis diet’. There may be different diets that help alleviate symptoms, such as a gluten free diet for example, but we can’t say for certain that a particular diet will improve fertility.
I would suggest taking the appropriate supplements such as iodine and folate, that are recommended for anyone trying to conceive.
Personally, I am a fan of acupuncture as it can help with both pain and fertility issues. There is some evidence to suggest that acupuncture can boost the chance of embryo transfer success with IVF.
How can I get more information?
We recommend that you speak with your GP or fertility specialist to discuss your personal situation.
If you’re a new client, you can book a 15 minute phone consultation with one of our fertility doctors. Get in touch with us today.
One of our clients shares their personal experience with trying to conceive with endometriosis. Read their story about trying different treatments and finally achieving success with their baby boy here.