These episodes of Infertility are focused on the problem known as endometriosis. Although
endometriosis can cause infertility and pain, on this channel we are focused on infertility.
In some cases, treatment for endometriosis such as surgery may help improve fertility
and relieve pain. I talk about surgery for endometriosis in this episode. In other cases,
such as hormone suppressing medications, treatment may help pain but will actually
interfere with attempts at pregnancy. Finally, treatments such as fertility medications,
IUI or IVF will improve fertility but not do anything about pain.
Endometriosis occurs when the tissue which is normally found inside of the uterine cavity,
grows outside of the uterus in the abdomen. We don’t know precisely how endometriosis
gets started but we do know that once you have it, the hormone estrogen can cause it to grow
and spread. Estrogen is produced primarily in the ovaries when an egg is maturing prior to
ovulation. Suppressing ovulation, therefore, can help control endometriosis. A number of different
medications can be used for this purpose. They can be very helpful for controlling pain. If you
are trying to conceive, however, you shouldn't use these medications. Since these medications
prevent ovulation, you can't get pregnant while you are taking them. They will actually make it
take longer to get pregnant by delaying when you can actually start trying to conceive.
In the past, some doctors would recommend using ovarian suppression for several months
after endometriosis surgery. However, studies now show that this does not
improve fertility and only delays when a person can start attempting pregnancy.
What about the use of fertility medications or intrauterine inseminations? Unfortunately,
we don’t have great studies on these treatments in which there are side by side comparisons. People
with normal fertility have a monthly pregnancy rate of around 20 to 25%. In a few different
studies, people with mild endometriosis had a monthly pregnancy rate between 2.8% and 4.5%
without any treatment at all. With the fertility medication clomid, the monthly rate was 6.6%.
When Clomid was combined with IUI instead of just intercourse, the monthly pregnancy rate was 9.5%.
One study compared the success using IUI with Clomid to another oral medication,
letrozole. The group they studied were people who had undergone surgical treatment for
endometriosis but did not conceive on their own for 6 months afterward. In this study,
the monthly chance for pregnancy was similar. About 15% became pregnant each month.
Studies using fertility injections with intercourse saw a monthly pregnancy rate
of around 6 to 7%. Injections of fertility medications combined
with IUI saw the monthly rate increase to between 13 to 15%.
Fertility medications with or without IUI would appear to increase the chance for
pregnancy in people with mild endometriosis. Their monthly
pregnancy rate is still not what we would expect for people with normal fertility.
What about IVF? IVF appears to be the most successful fertility treatment
for endometriosis. IVF can be used for people with mild endometriosis or severe
endometriosis. Success rates are similar to people who do not have endometriosis,
with one exception. People who have endometriosis cysts in their ovaries or people who have surgery
on their ovaries to remove endometriosis cysts, will often have a lower number of
eggs remaining in their ovaries. The people with decreased reserve have lower IVF success
rates. For this reason, we caution people about operating on the ovaries before IVF.
Our InfertilityTV Bottom Line is this. Suppression of the ovaries does not help
improve fertility in endometriosis patients. Fertility treatments using medications and
intrauterine inseminations are easy to do and appear to improve the chance for pregnancy,
though the evidence is not strong. IVF is the most successful treatment for endometriosis. People
will achieve more pregnancies and conceive them sooner than with any other treatment