What it is
Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside it, most often on the ovaries, the fallopian tubes and the lining of the pelvis. The World Health Organization estimates that it affects about 10% of women and girls of reproductive age worldwide.
Common symptoms are painful periods, pain during or after sex, and ongoing pelvic pain. Some women have no symptoms at all and learn about it only when they have trouble conceiving.
How it can affect fertility
According to the American Society for Reproductive Medicine, 30% to 50% of women with endometriosis experience infertility. Several things can be at work.
- Inflammation in the pelvis, which can affect the egg, the sperm and the embryo.
- Scar tissue and adhesions, which can change the position of the ovaries and tubes or block the tubes.
- Cysts on the ovaries called endometriomas, which can reduce the number of eggs.
It does not mean you can’t conceive
Many women with endometriosis, particularly milder forms, get pregnant without any treatment. How much it affects you depends on where the tissue is, how extensive it is, and your age.
Getting a diagnosis
Diagnosis is often slow, commonly several years from the first symptoms, in part because period pain is so often dismissed. Ultrasound or MRI can show endometriomas and deeper disease. A firm diagnosis usually comes from laparoscopy, a keyhole operation.
If your periods regularly stop you from living your life, that is worth raising with a doctor, whether or not you are thinking about children yet.
Your options
Treatment depends on your symptoms and your plans. Surgery to remove endometriosis can improve the chance of conceiving naturally in some cases. Fertility treatment, including IVF, is another route and is often recommended when the disease is more advanced or time matters.
One point is easy to miss. Surgery on the ovaries, especially removing endometriomas, can itself lower your egg reserve. If an operation is planned and you want children later, ask your doctor about testing your reserve beforehand and whether freezing eggs first makes sense for you.
How ovarian reserve is tested