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Endometriosis and Fertility

  • Dr. rer. nat. Birgit Wogatzky
  • March 6, 2024
  • 11:30 am
endometriosis fertility pregnancy

Endometriosis not only presents challenges in terms of pain management but also raises concerns about its potential effects on fertility. Understanding these complexities is crucial for women with endometriosis as they navigate their journey towards conception and pregnancy. Here’s what you need to know:

 

When Does Endometriosis Affect Fertility?

While many women with endometriosis conceive without difficulty, the condition can pose challenges in certain cases. The location of endometriomas, particularly on the ovaries, fallopian tubes, or within uterine muscles, may interfere with normal physiological functions necessary for conception and early embryo development. Surgical intervention to address adhesions and remove endometriomas can significantly improve the chances of pregnancy, but success isn’t guaranteed for all.

 

Hormonal Imbalances and Their Impact

Endometriosis often also disrupts the hormonal balance, with an excess of estrogen and insufficient progesterone being common. This imbalance, coupled with progesterone resistance, can perpetuate inflammation and further lesion development, creating a cycle that hampers fertility. Altered hormone levels, including luteinizing hormone (LH), can also affect follicle growth and ovulation, further complicating fertility.

 

Inflammation, Oxidative Stress, and Oocyte Quality

Inflammation associated with endometriosis contributes to increased oxidative stress, which can detrimentally affect oocyte quality. Elevated oxidative stress levels not only impair oocyte development but also genetic health. Consequently, women with endometriosis may face challenges related to both oocyte quantity and quality.

 

Fertility Treatment

Fortunately, fertility treatments offer promising outcomes for women with endometriosis. While medical interventions can address certain aspects of the condition, lifestyle modifications play a crucial role in optimizing treatment success. Adopting an anti-inflammatory diet rich in antioxidants can help protect oocytes from inflammation and oxidative stress, enhancing the efficacy of fertility treatments.

 

Pregnancy and Beyond

Despite the challenges posed by endometriosis, studies suggest that pregnant women with the condition typically experience pregnancies comparable to those without endometriosis. Symptoms often improve during pregnancy, and complications are generally manageable with close monitoring. While there’s no evidence of adverse effects on pregnancy or baby’s health, vigilance is necessary, particularly regarding conditions like placenta previa.

Contrary to past concerns, women with endometriosis can have uncomplicated deliveries akin to other women, though slightly higher blood loss might be experienced. Postpartum, supplementing with a multivitamin rich in iron and other essential nutrients can aid in recovery and support breastfeeding.

 

In conclusion, while endometriosis may present fertility challenges, proactive management and informed decision-making can significantly improve outcomes. By understanding the condition’s impact and embracing comprehensive care strategies, women with endometriosis can navigate their fertility journey with confidence.

 

 

References:

 

Al-Fadhli R, Kelly SM, Tulandi T, Tanr SL. Effects of different stages of endometriosis on the outcome of in vitro fertilization. J Obstet Gynaecol Can. 2006; 28:888–891.

Allaire C. Endometriosis and infertility: a review. J Reprod Med. 2006; 51:164–168.

Augoulea A, Mastorakos G, Lambrinoudaki I, Christodoulakos G, Creatsas G. The role of the oxidative-stress in the endometriosis-related infertility. Gynecol Endocrinol. 2009;25:75–81.

Bancroft K, Williams CAV, Elstein M. Pituitary–ovarian function in women with minimal or mild endometriosis and otherwise unexplained infertility. Clin Endocrinol. 1992;36:177–181.

Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet. 2010;27:441–447.

Carvalho LF, Abrão MS, Biscotti C, Sharma R, Nutter B, Falcone T. Oxidative cell injury as a predictor of endometriosis progression. Reprod Sci. 2013 Jun;20(6):688-98.

Chen I et al. Association between surgically diagnosed endometriosis and adverse pregnancy outcomes. Fertil Steril. 2018 Jan;109(1):142-147.

Coddington CC, Oehninger S, Cunningham DS, Hansen K, Sueldo CE, Hodgen GD. Peritoneal fluid from patients with endometriosis decreases sperm binding to the zona pellucida in the hemizona assay: a preliminary report. Fertil Steril. 1992;57:783–786.

Garrido N, Navarro J, Remohi J, Simon C, Pellicer A. Follicular hormonal environment and embryo quality in women with endometriosis. Hum Reprod Update. 2000;6:67–74.

Garrido N, Navarro J, Garcia-Velasco J, Remoh J, Pellice A, Simon C. The endometrium versus embryonic quality in endometriosis-related infertility. Hum Reprod Update. 2002;8:95–103.

Garrido N, Pellicer A, Remohi J, Simon C. Uterine and ovarian function in endometriosis. Semin Reprod Med. 2003;21:183–192.

González-Comadran M et al. The impact of endometriosis on the outcome of Assisted Reproductive Technology. Reprod Biol Endocrinol. 2017 Jan 24;15(1):8.Gupta S, Ashok Agarwala A. Role of oxidative stress in endometriosis. RBM online 2006, Volume 13, Issue 1, Pages 1261/ww

Harada T, Yoshioka H, Yoshida S, Iwabe T, Onohara Y, Tanikawa M, Terakawa N. Increased interleukin-6 levels in peritoneal fluid of infertile patients with active endometriosis. Am J Obstet Gynecol. 1997;176:593–597.

Iwabe T, Harada T, Terakawa N. Role of cytokines in endometriosis-associated infertility.Gynecol Obstet Invest. 2002;53:19–25.

Jackson LW, Schisterman EF, Dey-Rao R, Browne R, Armstrong D. Oxidative stress and endometriosis. Hum Reprod. 2005;20:2014–2020.

Jana SK, K NB, Chattopadhyay R, Chakravarty B, Chaudhury K. Upper control limit of reactive oxygen species in follicular fluid beyond which viable embryo formation is not favorable.Reprod Toxicol. 2010;29:447–451.

Kissler S, Zangos S, Wiegratz I, Kohl J, Rody A, Gaetje R, Doebert N, Wildt L, Kunz G, Leyendecker G, et al. Utero-tubal sperm transport and its impairment in endometriosis and adenomyosis. Ann N Y Acad Sci. 2007;1101:38–48.

Mansour G, Aziz N, Sharma R, Falcone T, Goldberg J, Agarwal A. The impact of peritoneal fluid from healthy women and from women with endometriosis on sperm DNA and its relationship to the sperm deformity index. Fertil Steril. 2009;92:61–67.

Marquardt RM, Kim TH, Shin JH, Jeong JW. Progesterone and Estrogen Signaling in the Endometrium: What Goes Wrong in Endometriosis? Int J Mol Sci. 2019 Aug 5;20(15):3822. doi: 10.3390/ijms20153822.

Nirgianakis K, Gasparri ML, Radan AP, Villiger A, McKinnon B, Mosimann B, Papadia A, Mueller MD. Obstetric complications after laparoscopic excision of posterior deep infiltrating endometriosis: a case-control study. Fertil Steril. 2018 Aug;110(3):459-466. doi: 10.1016/j.fertnstert.2018.04.036. PMID: 30098698.

Reeve L, Lashen H, Pacey AA. Endometriosis affects sperm-endosalpingeal interactions. Hum Reprod. 2005;20:448–451.

Singh AK, Chattopadhyay R, Chakravarty B, Chaudhury K. Markers of oxidative stress in follicular fluid of women with endometriosis and tubal infertility undergoing IVF. Reprod Toxicol. 2013 Aug 28.

Yoshida S, Harada T, Iwabe T, Taniguchi F, Mitsunari M, Yamauchi N, Deura I, Horie S, Terakawa N. A combination of interleukin-6 and its soluble receptor impairs sperm motility: implications in infertility associated with endometriosis. Hum Reprod. 2004; 19:1821–1825.

Zeller JM, Henig I, Radwanska E, Dmowski WP. Enhancement of human monocyte and peritoneal macrophage chemiluminescence activities in women with endometriosis. Am J Reprod Immunol Microbiol. 1987;13:78–82.

 

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