Endometriosis is a gynaecological condition that affects 1 in 9 women in Australia. The inside of your uterus (womb) is lined by a tissue known as the endometrium. In endometriosis, these endometrial cells develop elsewhere, such as behind the uterus or around your fallopian tubes and ovaries. In severe cases, abnormal endometrial tissue can even be found around your diaphragm, bowel, or bladder.
An associated condition known as adenomyosis occurs when abnormal endometrial tissue grows into the muscle wall of the uterus. Endometriosis and adenomyosis share many of the same symptoms.
Endometriosis can be challenging to diagnose. To confirm a diagnosis, we need to perform laparoscopic surgery. Although this procedure is a minimally-invasive keyhole technique, it still comes with risks. These risks include infection, bleeding, or accidental trauma to nearby internal organs.
The predominant symptom of endometriosis is pain, particularly around the time of your menstrual period. Although these abnormal growths of endometrial cells are outside of your uterus, they still go through the monthly cycle of breaking down and trying to shed from your body. This process causes chronic inflammation, resulting in severe and debilitating pain for many women. However, the pelvic pain associated with endometriosis may be constant for some, not just associated with menstruation. Endometriosis can also cause pain during sexual intercourse, or with going to the toilet.
Other common symptoms of endometriosis include:
The symptoms of endometriosis can also be present in women without endometriosis, which may complicate the diagnosis and cause delays in women seeking timely treatment. Conversely, some people with endometriosis are asymptomatic.
Not all women who have endometriosis are impacted by infertility. It is very possible to have a confirmed diagnosis of endometriosis yet still be able to conceive naturally and spontaneously.
Between 30-50% of women with endometriosis will have trouble conceiving. The chronic inflammation associated with the condition can cause scarring and damage to many of the anatomical structures needed for falling pregnant and maintaining the pregnancy. This can get in the way of sperm fertilising your egg or an embryo implanting in your uterus.
If your endometriosis is mild, we may suggest trying to improve your chances of natural conception through strategies such as reviewing your lifestyle habits or ovulation tracking. If this approach is not suitable for your situation or is unsuccessful, we may consider:
Laparoscopic surgery with a specialist experienced with endometriosis can remove areas of abnormal tissue growth to help restore normal fertility. A laparoscopy may also help address other complications of endometriosis contributing to infertility such as bands of scar tissue, known as adhesions.
IVF and IUI are both forms of assisted reproductive technologies. IUI involves inserting your partner’s (or donor) prepared sperm directly into your uterus. The IVF procedure involves collecting your eggs and combining them with your partner’s (or donor) sperm in a laboratory dish. The decision on whether IUI or IVF is more appropriate for you depends on the stage and severity of your endometriosis, and whether there are other infertility factors present.