Endometriosis & fertility.
Endometriosis is a chronic condition in which affected women suffer from severe cycle-related pain – and which affects up to 40 % of all infertile women. Patches of the uterine lining are found outside the uterus, for example on the peritoneum, the ovaries or the fallopian tubes.
How endometriosis affects fertility.
The most common signs are increased pain during menstruation. The endometriosis lesions can, on the one hand, impair the function of the fallopian tubes; on the other hand, if the ovaries are affected, egg maturation and ovulation can be hindered. In patients who have already undergone endometriosis surgery, ovarian function may be reduced as a result of the operation – here the AMH level provides information about the remaining ovarian reserve.
This is why patients suffering from endometriosis often have to turn to assisted reproduction to fulfil their longed-for wish for a child. Freezing eggs or embryos before endometriosis surgery can also be considered if it is expected that the ovary could be damaged.
Recognising endometriosis: typical symptoms.
Endometriosis affects around one in ten women of childbearing age – and yet often goes undetected for years, because the symptoms are misinterpreted as "normal" period pain. Typical signs are severe, cramp-like pain during menstruation, pain during intercourse, chronic lower abdominal or back pain, and cycle-related discomfort during bowel movements or urination. Some women, however, have pronounced lesions without any symptoms at all – and only learn of their endometriosis during a fertility work-up.
Suspicion is raised by a careful medical history and an ultrasound examination; final certainty comes from a laparoscopy, during which lesions can also be removed directly. For fertility treatment, however, surgical confirmation of the diagnosis is not always necessary – therapy can often be started right away.
One of the most comprehensive endometriosis studies worldwide.
Good news from research.
Priv.-Doz. DDr. Michael Feichtinger has conducted one of the most comprehensive studies worldwide to date, with more than 2,500 childless couples and over 8,000 treatment cycles, to investigate the influence of endometriosis on fertility treatment. This study was also the first to analyse the cumulative pregnancy rate (live birth after repeated assisted reproduction cycles) in endometriosis.
The result: endometriosis does not negatively affect the outcome of fertility treatment. As expected, patients with endometriosis had fewer eggs after IVF stimulation, but the cumulative "baby take-home rate" was not reduced compared with women without endometriosis.
These data show that patients with endometriosis, just like other women, can be advised to have a single embryo transfer followed by frozen embryo cycles – i.e. the transfer of surplus frozen embryos – in order to maximise the number of pregnant patients and minimise obstetric complications.
Especially when the wish for a child is central for endometriosis patients, assisted reproduction should be preferred over surgery because of its high efficiency.
Endometriosis and the wish for a child: surgery or assisted reproduction?
Which path is right depends on your symptoms, the findings and above all on your wish for a child. Surgery can make sense in cases of severe pain – but operations on the ovary can cost valuable egg tissue. If having a child is the priority, assisted reproduction with IVF or ICSI is therefore often the more efficient option. Before planned endometriosis surgery, precautionary freezing of eggs or embryos (cryopreservation) can also be considered.
With us you get both from a single source: a careful work-up – including AMH testing in our own hormone laboratory – and a treatment plan that fits your life situation, accompanied by our whole team in the spirit of 360° care. The best way to take the first, non-binding step is a first fertility consultation in Vienna, Baden or St. Pölten.
Endometriosis is only one of many possible causes
You will find an overview of all the common reasons for an unfulfilled wish for a child – from female fertility and PMOS (formerly PCOS) to male infertility – on our causes page.
Endometriosis and fertility: your questions.
Can I get pregnant at all with endometriosis?
Yes. Many women with endometriosis become pregnant spontaneously, others need support. The study data from our institute show that the cumulative chance of a baby after assisted reproduction is not reduced in endometriosis patients – endometriosis and the wish for a child are therefore not mutually exclusive.
How do I know whether my period pain points to endometriosis?
You should take notice if the pain is so severe that it interferes with everyday life, painkillers barely help, or you additionally experience pain during intercourse, bowel movements or urination. Such symptoms are not "normal" and should be checked by a gynaecologist.
Do I need surgery before fertility treatment?
No, not necessarily. If having a child is the priority, assisted reproduction is often the better first choice because of its high efficiency – surgery can cost ovarian tissue and reduce the ovarian reserve. Whether and when surgery makes sense is something we discuss with you individually.
Does endometriosis affect my AMH level?
Endometriosis can affect the ovarian reserve – especially if the ovaries are involved or have already been operated on. That is why determining the AMH level is a fixed part of the work-up for endometriosis patients with a wish for a child at our institute.
What is a "chocolate cyst" (endometrioma)?
An endometrioma is an endometriosis cyst on the ovary filled with thickened, old blood – hence the name "chocolate cyst". Endometriomas are benign, but they can impair ovarian function and should be taken into account in treatment planning if you wish to have children.
Should I have eggs frozen before endometriosis surgery?
If it is foreseeable that an operation on the ovary could reduce the ovarian reserve, precautionary freezing of eggs or embryos can be a sensible safeguard. We are happy to advise you before the planned operation – ideally in coordination with your surgical team.
Do symptoms improve during pregnancy or after menopause?
Since endometriosis symptoms are cycle-related, they improve in many women during pregnancy and after menopause. However, this is not guaranteed, and lesions can recur after surgery – long-term gynaecological care is therefore important.
We fulfil your wish for a child!
Endometriosis and the wish for a child are not mutually exclusive – let's plan your path together.
Or call us: +43 1 877 77 75