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Endometriose
What is endometriosis?
Endometriosis is a condition where small areas of endometrium are found in the abdominal cavity and on other internal organs such as the bowel and bladder, while on the ovaries so-called chocolate cysts can have formed.
This endometrium is affected by hormones in the same way as the lining inside the uterus. When a woman has her period, these small areas in the abdomen will also bleed, which in most cases causes pain. The nature of the pain is highly individual, but can be very severe and almost debilitating.
Endometriosis is a relatively common disease among women of childbearing age. It is estimated that approximately 6-10% suffer from the disease to a greater or lesser degree.
Why do I have endometriosis?
The cause of endometriosis is unknown, but there are various hypotheses. One of them is that there has been a backflow of blood and tissue through the fallopian tubes into the abdominal cavity. Some of the mucosa has then grown onto the bowel, ovary or peritoneum. If you have a mother or sister with endometriosis, there is an increased risk that you also have endometriosis.
How does endometriosis affect my fertility?
Endometriosis is found in about 30% of women who are screened for infertility. It can affect fertility in several ways:
- Scar tissue that disrupts the function of the fallopian tubes.
- Chocolate cysts that inhibit ovarian tissue from producing viable eggs.
- Surgical removal of cysts that have led to a reduced egg reserve.
- Constant inflammation (irritation) in the abdomen, which can make eggs less likely to attach to the lining.
Fertility treatment for endometriosis
Treatment for women with endometriosis depends on the stage of endometriosis. Women with moderate to severe endometriosis will always be recommended IVF treatment as soon as possible.
Surgical removal of cysts before starting fertility treatment is an expert judgement. Many studies suggest that surgery does not increase the chance of pregnancy. However, it can alleviate certain symptoms and facilitate and enable egg retrieval.
Down-regulation and IVF treatment
To reduce endometriosis and the inflammation (irritation of surrounding tissue) caused by endometriosis, down-regulation is performed.
Down-regulation can last from 14 days to 3 months. This depends on the nature of the endometriosis and your medical history. It is a professional assessment made by the fertility doctor.
Down-regulation means that you will receive medical treatment. Endometriosis is “nourished” by oestrogen in particular, so downregulation inhibits and starves the endometriosis. Most people experience a clear improvement in their symptoms during this period. Some studies show a higher pregnancy rate after downregulation in connection with IVF treatment.
Endometriosis can be the cause of low egg count and/or poor egg quality. With egg donation, you have almost the same chance of pregnancy as women without endometriosis.
30% of women with endometriosis will have adenomyosis, which are changes in the uterus that can affect fertility.
