WHAT YOU NEED TO KNOW Optimising Fertility with Endometriosis

March is Endometriosis Awareness Month, an important time to raise awareness about this common yet often misunderstood condition that affects an estimated 1 in 9 women of reproductive age in Australia. Endometriosis can have a profound impact not only on a woman’s day-to-day life but also on her fertility. In this article, Dr. Simon Nothman explores what endometriosis is, how it affects fertility, and what treatment options are available for women hoping to conceive.

What is Endometriosis?

Endometriosis occurs when tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This misplaced tissue responds to hormonal changes each month, just like the uterine lining, but unlike menstrual blood, it has no way to exit the body. As a result, endometriosis can cause inflammation, scar tissue, cysts (endometriomas), and adhesions.

Common areas affected include the ovaries, fallopian tubes, outer surface of the uterus, and surrounding pelvic organs.

What Are the Symptoms of Endometriosis?

Endometriosis symptoms can vary widely. Some women may have no symptoms and only discover they have endometriosis when they struggle to conceive. However, common symptoms include:

• Painful periods (dysmenorrhea)
• Pelvic pain, especially around menstruation
• Pain during intercourse
• Pain with bowel movements or urination, particularly during menstruation
• Heavy menstrual bleeding
• Fatigue
• Sometimes, difficulty conceiving (infertility) may be the first indication

It’s important to note that the severity of symptoms doesn’t always correlate with the severity of the disease – some women have significant symptoms but minimal objective findings or vice versa.

How Does Endometriosis Affect Fertility?

Endometriosis can impact fertility in several ways:

• Distorted pelvic anatomy due to adhesions and scar tissue, which can block or impair the function of fallopian tubes and prevent regular transport of eggs and sperm.
• Inflammation in the pelvic cavity may interfere with egg quality, fertilisation, and embryo implantation.
• The presence of endometriomas (cysts on the ovaries) may reduce ovarian reserve (the number and quality of eggs), as can the surgeries to remove them.
• Hormonal disruptions affecting ovulation and the uterine environment for implantation.

While some women with endometriosis conceive naturally, others may require medical assistance to achieve pregnancy.

Diagnosis of Endometriosis

Diagnosing endometriosis can be challenging because symptoms overlap with other conditions. A thorough assessment typically includes:

• Medical history and symptom review
• Pelvic examination
• Pelvic ultrasound (although this may not detect all forms of endometriosis)
• Laparoscopy (a keyhole surgery) remains the gold standard for diagnosis and allows for treatment simultaneously, however
• Occasional MRI may be helpful for surgical planning.

Treatment Options for Endometriosis and Fertility

Management of endometriosis depends on whether a woman is trying to conceive and the severity of her symptoms.

1. Surgical Treatment

   • Laparoscopic surgery to remove or destroy endometriotic lesions and adhesions may improve pain and fertility.
   • Surgery also has the potential to cause surgical damage- particularly reduced ovarian reserve and pelvic adhesions.
   • Surgery can also remove endometriomas, although careful consideration is needed to avoid reducing ovarian reserve.

2. Assisted Reproductive Technologies (ART)

   • Ovulation induction and intrauterine insemination (IUI) may be considered in mild cases. While this can be trialled, most studies suggest it is of questionable value and should not be relied upon beyond a couple of attempts.
   • In vitro fertilisation (IVF) is often recommended for moderate to severe cases or when other methods have failed. IVF can bypass many of the issues caused by pelvic adhesions and inflammation.
   • Egg Freezing: In women with endometriosis who may require pelvic surgery — particularly those with ovarian endometriomas — egg freezing can be an essential strategy to preserve fertility. Surgery to remove endometriotic lesions or cysts may reduce ovarian reserve, so egg freezing provides an option to protect future reproductive choices.

3. Medical Management (when not trying to conceive)

   • Hormonal therapies (such as the contraceptive pill, progestins, or GnRH agonists) can suppress endometriosis growth and reduce symptoms but are generally not used when pregnancy is desired.

When to See a Fertility Specialist

While the general recommendation is to see a fertility specialist after 6–12 months of unsuccessful attempts to conceive, if you have known or suspected endometriosis, there is no need to suffer through such attempts for so long.

In such circumstances, consulting with a fertility specialist like Dr Simon Nothman is advisable sooner rather than later. Early evaluation and intervention can improve your chances of achieving a healthy pregnancy.

Key Takeaways

• Endometriosis is a common cause of pelvic pain and infertility.
• The severity of symptoms doesn’t always predict fertility challenges.
• Effective treatments are available, including surgery and assisted reproduction.
• Egg Freezing can be essential, especially for those requiring pelvic surgery.
• Early diagnosis and personalised care are key to managing endometriosis and protecting fertility.

Endometriosis Awareness Month: Take Control of Your Fertility Journey

March is Endometriosis Awareness Month, an ideal time to seek help if you suspect endometriosis or are facing fertility concerns. If you’re in Sydney, Bondi Junction, or surrounding areas, Dr. Simon Nothman can provide a comprehensive assessment and discuss your fertility options.

Book a Consultation Today

If you are struggling with symptoms of endometriosis or facing fertility challenges, contact Dr. Simon Nothman’s clinic today to arrange a consultation – including telehealth appointments where appropriate. Together, we can explore personalised treatment options to support your path to parenthood.