Endometriosis & fertility
Last week I gave a presentation at the 2nd National Sexual and Reproductive Health Conference. The conference was held in Melbourne and attended by various professionals working within health including doctors, biologists, social workers, and many more.
The aim of my presentation was to examine what women are told by their doctors about endometriosis and fertility. I think the two areas I focused on within this broad topic may be of interest to many.
Conception in women with endometriosis
I often see information (even on ‘trustworthy’ websites) state that 30-40% of women with endometriosis experience infertility. This statistic stems from a study conducted in the 1930s!! While research suggests an association between endometriosis and infertility there are no recent, good quality studies available to tell us the strength of this association. So we don’t know if an endometriosis diagnosis means a woman is much more likely to experience infertility or only a small bit more likely to, compared to someone who hasn’t been diagnosed with the condition.
The effect of pregnancy on endometriosis symptoms
Progesterone is a hormone that is thought to suppress the growth of endometriosis disease. Some believe that pregnancy may be beneficial in reducing the symptoms of endometriosis due to the high levels of progesterone produced at this time.
BUT anecdotal evidence suggests that some women may actually experience a worsening of symptoms because of pregnancy. Estrogen is a hormone thought to contribute to the growth of endometriosis. High levels of estrogen are produced during early pregnancy and the uterus also rapidly grows during this time; these two factors could contribute to a worsening of symptoms.
Overall, there is no evidence to support pregnancy as a ‘treatment’ option for endometriosis.
So what does this mean for women?
I’m going to take my researcher hat off for a second and talk as a woman with endometriosis. It is frustrating to hear that you have an increased risk of infertility but that no one knows just how much of an increased risk this is. It is frustrating to be told by (a no doubt well meaning) doctor that I should consider having a baby at the age of 22 to prevent my condition from getting worse (which, as we learned above, there is no evidence for).
This might sound odd to some but I would be relieved if someone told me I was definitely infertile. No more wondering if I need contraception or if I should (or can) have children. Decision made. My partner and I can grieve and then move on. It's the not knowing that is the worst part.
*Puts researcher hat back on*
Here are some things that we do know: age is the biggest factor associated with fertility and those who experience infertility (for reasons other than age) often still have a baby eventually either with medical intervention or time (or both). So basically time is your biggest ally; the sooner you can get started the better your chances are (easier said than done for many, I know! See suggestions for how to plan your reproductive life here.)
At the very least I hope this post has cleared up some of the misconceptions women encounter about endometriosis and fertility. I wish I could provide more concrete information but (like many things in life) when it comes to endometriosis there seems to only be shades of grey rather than black and white.
Please feel free to share your experience or thoughts and feelings about endometriosis and fertility below.
Image via Death to the Stock Photo
Image via Death to the Stock Photo