Infertility and endometriosis

Endometriosis is found in 15-25% (1 in 4-7) of the infertile women. On the other hand, the incidence of infertility in women with endometriosis is 20-65% (2 in 3-10). Its usual symptoms include pain just before and during periods (progressive dysmenorrhoea), painful sexual intercourse (dyspareunia) and pelvic pain, infertility etc (Triad of endometriosis). The cause of endometriosis is unknown. There is a familial tendency (more maternal link) suggesting some genetic predisposition.

The management of infertility associated with endometriosis includes:

 Laparoscopic surgery 

â–ºThis is the best option. The cumulative success rate is 23-81% depending on the severity of endometriosis, female partner’s age and presence of other factors. It requires a Gynaecologist skilled in doing laparoscopic surgery for endometriosis (needs operative skills far greater than doing a diagnostic laparoscopy that is commonly performed to have a look) and proper operation theatre facilities, and is relatively expensive.

â–ºMedical treatment does not have any significant role in improving fertility as it causes anovulation during the treatment period. It is useful for treating pelvic pain that is associated with endometriosis, but not for treating infertility.

 IUI (stimulated)

 â–ºThe success rate is about 12-23% depending on the female partner’s age, presence of other factors etc. How IUI improves pregnancy rate in women with endometriosis is not clear. 

 IVF 

â–ºThe success rate is lower in the presence of endometrioma (ovarian cyst). The success rate improves if the endometrioma is removed (preferably laparoscopically) before IVF.