Does Endometriosis affect IVF success?
Do you struggle with severe menstrual cramps, or other symptoms that might indicate you have endometriosis? While official statistics[1] show that about 1 in 10 women in their childbearing years here suffer from this condition, there may be more unreported cases than you think: A recent survey conducted by NUH, SGH and KKH among 2,522 women found that over 50% suffer from symptoms that suggest possible endometriosis or other gynaecological conditions.
These symptoms include:
- Difficulty conceiving/infertility
- Extreme menstrual cramps
- Excessive or unusual bleeding during menstruation
- Pain in the back during menstruation
- Pain during sexual intercourse
- Persistent fatigue
Even so, 20-25%[2] of women do not display symptoms – this is known as “silent endometriosis”. If you have been consistently unsuccessful in getting pregnant and crossed out all the other factors for infertility, consider getting screened for endometriosis – especially before trying for IUI or IVF.
In this article, we’ll discuss how endometriosis affects fertility, if endometriosis plays a role in IVF success rates and whether to treat the condition before opting for IVF.
How does endometriosis affect fertility?
Endometriosis is a condition where tissue from the uterine lining is found outside the uterus. This displaced endometrial-like tissue acts in response to hormonal changes, meaning they can mature and bleed at any point through your menstrual cycle.
When this happens, the area surrounding the endometrial tissue becomes inflamed, resulting in extreme pain. This occurrence can also influence fertility in several ways[3]:
What is affected | How it contributes to infertility |
Quality of egg | The inflammation caused by endometriosis around the reproductive organs can influence the development and quality of the egg, as well as its fertilization and implantation in the womb. The presence of scar tissue surrounding the ovaries can also have an effect on the flow of blood and supply of oxygen for the ovaries, resulting in suboptimal egg quality. |
Obstructions in the reproductive system | Adhesions, cysts and scar tissue are different factors that can build up in and around the different organs of the reproductive system, hindering the process of conception. These factors can block the pathway in which a mature egg passes to get to the uterus. |
Painful sex | Many patients with endometriosis experience painful sexual intercourse, causing them to lose the desire to be intimate entirely. |
Does endometriosis affect IVF success rates?
Unfortunately, endometriosis does affect the success of in-vitro fertilization (IVF) treatment – this is mainly due to lower oocyte and embryo quality, as well as chronic inflammation of the ovary, uterine cavity and peritoneal cavity which affects the implantation of embryos.
But all hope is not lost – it is still possible to achieve IVF success. The key is to manage your condition before commencing IVF treatment, and time the cycle accurately[4].
Is the IVF process different for women with endometriosis?
Yes, the IVF process will be slightly different.
As estrogen levels spike during the egg retrieval phase of IVF, it can possibly make endometriosis lesions bigger, causing more symptoms in the patient. Depending on the severity of your condition e.g. your endometriosis is too severe to safely access your follicles, your doctor may suggest surgery, provide medication or suggest an alternative procedure that poses minimal risk.
Your best bet is to work with a fertility specialist experienced in endometriosis.
Should you treat endometriosis first before opting for IVF?
Some studies[5] suggest that it may be beneficial for certain patients to undergo medical treatments that contain gonadotropin-releasing hormone (GnRH) agonist medication prior to IVF.
This treatment is administered 3-6 months before IVF, and is believed to lead to the waning of endometriosis, thereby increasing the chances of fertility. However, it is important to note that further studies are needed to cement the proven and positive effects of GnRH agonist treatment ahead of IVF, as there is no solid evidence that proves GnRH has a positive effect on IVF conception or live birth rates.
Generally, surgery is often proposed as a pre-treatment before IVF. This surgery is often done with laparoscopy or laparotomy. Below is a table showing a comparison of the two procedures:
Laparoscopy | Laparotomy |
Minimally invasive | Major surgery |
Performed using general anaesthesia | Performed using general anaesthesia |
Requires small incisions to the abdominal area | Requires larger incisions to the abdominal area |
No pain felt during the procedure as patient is asleep | No pain felt during the procedure as patient is asleep |
Shorter downtime following the procedure; patient is allowed to go home after the surgery | Longer downtime following the procedure; may require overnight stay in the hospital for monitoring |
| Uses a laparoscope | Uses surgical tools |
It is important that endometriomas are removed through surgery to suppress inflammation and reinstate regular pelvic anatomy before the IVF cycle starts. Fertility specialists may also encourage women who have endometriosis to freeze their eggs at a younger age to increase IVF success.
Read: What is egg freezing, and does it guarantee pregnancy?
Final thoughts
While endometriosis can affect fertility, it does not mean you should give up hope of creating your own family – technologies like IVF were invented to help couples conceive. Contact us today to find out more about our fertility programs.
References
- Chong, C. (2022, March 7). Menstrual pain could be endometriosis; affects 1 in 10 females in child-bearing years in S’pore. The Straits Times. Retrieved July 18, 2022, from https://www.straitstimes.com/singapore/menstrual-pain-could-be-endometriosis-affects-1-in-10-women-in-child-bearing-years-here
- Bulletti, C., Coccia, M. E., Battistoni, S., & Borini, A. (2010). Endometriosis and infertility. Journal of Assisted Reproduction and Genetics, 27(8), 441–447. https://doi.org/10.1007/s10815-010-9436-1
- https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/endometriosis-does-it-cause-infertility/#:~:text=Endometriosis%20can%20influence%20fertility%20in,pregnancy%2C%20and%20altered%20egg%20quality.
- Zhong, C., Gao, L., Shu, L., Hou, Z., Cai, L., Huang, J., Liu, J., & Mao, Y. (2021). Analysis of IVF/ICSI Outcomes in Endometriosis Patients With Recurrent Implantation Failure: Influence on Cumulative Live Birth Rate. Frontiers in Endocrinology, 12. https://doi.org/10.3389/fendo.2021.640288
- Kuivasaari, P., Hippeläinen, M., Anttila, M., & Heinonen, S. (2005). Effect of endometriosis on IVF/ICSI outcome: stage III/IV endometriosis worsens cumulative pregnancy and live-born rates. Human reproduction (Oxford, England), 20(11), 3130–3135. https://doi.org/10.1093/humrep/dei176