“Often, endometriosis is diagnosed when a couple is experiencing infertility when all other tests are within normal limits,” says Robyn Elise Weiss, About.com’s pregnancy and birth guide and the author of The Everything Getting Pregnant Book (Adams, 2004). Even then, a definite diagnosis is difficult without surgery.
“Conventional testing [such as ultrasound or MRI] may not show much. Laparoscopy—using a scope in the pelvic cavity to look for endometrial tissue or lesions—is the gold standard when it comes to obtaining a definitive diagnosis,” says Spencer Richlin, MD, a specialist in reproductive endocrinology at Reproductive Medicine Associates of Connecticut in Norwalk.
Studies by ACOG have found that 20 to 50 percent of women having fertility problems suffer from endometriosis, making it a leading cause of female infertility. But endo is not always a bar to getting pregnant; roughly 60 to 70 percent of women with the disease have no problem conceiving, according to experts at the National Institutes of Health (NIH). How and where endometrial tissue lands in the body seems to determine the difference. “Fertility is affected by a distortion of reproductive organs, through scarring or the impaired positioning between the end of the fallopian tube and ovary,” says Dr. Richlin. “Simply put, the tubes may be malpositioned to pick up the egg.”
Endometriosis may also interfere with egg development, due to increased fluid, inflammation, and antibodies. Even if an egg is fertilized, endometrial scarring can obstruct the fallopian tubes and block the egg’s travel to the womb. The uterus may also be decreasingly receptive to implantation.
Fortunately, treatment for endometriosis-related infertility has a high success rate—and often the physician is able to complete treatment at the time of the original laparoscopy. “A lot of times, especially for women who are found to have mild to moderate endometriosis, the tissue will be removed during the diagnostic procedure,” Dr. Richlin explains.
One of two surgical procedures can be used to diagnose endometriosis. The first, a laparoscopy, involves inserting a small wire with a light on the end of it through a small incision, usually near the navel. Some studies show that simply having this procedure can double the chances of getting pregnant among women with mild endometriosis, according to the NIH. The second option, a laparotomy, is more invasive and requires general anesthesia and an incision in the abdomen. Any abnormal tissue can be biopsied for endometrial cells. In either of these cases, the excess tissue can be cut out or ablated (burned) to clean the area and make pregnancy more likely.
Endometriosis often recurs, so most experts urge women to try getting pregnant soon after surgery for optimal results. Usually, women under 35 are given three or four months to attempt getting pregnant on their own, Dr. Richlin says. “If conception doesn’t happen, patients move onto ovulation induction and artificial insemination or, if the relationship between the ovary and the fallopian tube is impaired or the endometriosis is severe, in vitro fertilization,” he says.
Endometriosis may also be treated with drugs or hormones; however, since the most common hormonal treatments are the birth control pill or other conception-blocking hormones, this is clearly not the treatment of choice for a woman who is trying to become pregnant. Keep in mind that many women with endometriosis get pregnant without treatment, and are no more likely to have problem pregnancies than any other women.