Endometriosis causes infertility

Endometriosis and the desire to have children: not pregnant because of endometriosis?

Unfulfilled desire to have children and severe menstrual pain - an alarming combination behind which the disease endometriosis can hide. It is often discovered late. But it doesn't have to be.

Endometriosis - what is it?

It is estimated that around ten percent of women of childbearing age suffer from endometriosis. This means that the lining of the uterus (endometrium) is not only formed in the uterus, but also in other parts of the body - most often in the abdomen. Then, for example, on the abdominal wall, on the intestines, on the bladder, in the uterine muscles, on the uterine ligaments as well as on the fallopian tubes and ovaries, tissue nests that behave in a similar way to the mucous membrane in the uterus: they are built up and broken down under the control of the sex hormones and bleed cyclically. The problem: outside of the uterus, these scraps of mucous membrane cannot bleed off, so they get bigger, become inflamed and break open. This causes scarring, which affects the function of the fallopian tubes and ovaries, among other things.

What pain does endometriosis cause?

The most common is severe pain, especially during menstruation. But also during sexual intercourse, when emptying the intestines and bladder, or even all the time - depending on where the scattered islands of mucous membrane are located in the body.

What causes endometriosis?

Endometriosis is not only one of the most common, but also one of the most puzzling phenomena in gynecology. To this day, it is not known exactly how the disease develops. There is the so-called entrainment and implantation theory, according to which the mucous membrane cells get through the fallopian tubes, veins and lymph vessels and from the uterus into the rest of the body during abdominal operations. But this does not explain why not all women of childbearing potential develop endometriosis. It is believed that women with endometriosis have an additional - probably hereditary - immune deficiency that prevents the natural breakdown of the mucous membrane cells that have been carried over and thus gives them the opportunity to establish themselves and multiply. Although no endometriosis gene has yet been found, it is known that there is a familial accumulation. The individual risk increases if first-degree relatives, i.e. the mother or a sister, have endometriosis.

Why does endometriosis affect fertility?

Because the nests of the mucous membrane in the abdomen, which have lost their way, disrupt the interplay of the female reproductive organs. Endometriosis tissue embedded in the ovary disrupts the cycle, hampers egg maturation and ovulation. If the lost mucous membrane grows in the fallopian tube, there are problems with fertilization and egg transport. And in the area of ​​the uterus, the misdirected mucous membrane impairs the implantation of the fertilized egg.

How does my doctor diagnose endometriosis?

Diagnosing endometriosis is difficult even for experts. Some nodes can be felt or located by ultrasound, but the only thing you can be sure of is a look inside your stomach. With the necessary laparoscopy, which is done under general anesthesia, doctors are very cautious, especially with younger women who want to have children. Understandable when you consider that the reproductive organs can also be accidentally injured during this abdominal operation. The downside of medical caution: on average, the diagnosis of endometriosis is only made six to nine years after the first symptoms appear.

How are the endometriosis nests removed?

Through a laparoscopy: To do this, the surgeon first pushes a small viewing device and a tactile rod through two short cuts in the abdominal wall into the body and uses it to check the entire abdominal cavity. He then inserts special surgical instruments into the abdomen through the same or additional openings, takes tissue samples, removes endometriosis nodes, loosens adhesions and checks whether the fallopian tubes are free and mobile. This coupling of diagnosis and treatment means that many patients are spared further surgical interventions.

Endometriosis operated on, patient pregnant?

Unfortunately, the problem is not solved that easily. What happens after the laparoscopy for patients who wish to have children depends on the results of the examinations and on the individual situation of the woman and her partner. If the endometriosis foci appear to have largely been eliminated, the fallopian tubes are free and the partner is fully fertile, there is initially nothing further for the doctor to do. However, if not all islands of the mucous membrane could be removed, hormone withdrawal therapy lasting three to six months can be useful. It lets the remaining endometriosis herd "starve" by inhibiting the body's own estrogen and gestagen production.

Help through fertility therapies

The ideal and most natural hormone withdrawal therapy is pregnancy, which also paralyzes the ovaries for almost ten months. But many women with endometriosis wait in vain for this most welcome therapy, even after the treatment. Either because they are already at an age when fertility declines. Or because they have other fertility problems besides endometriosis, for example with the fallopian tubes. Or because your partner is only partially fertile.
But these women also have a chance of becoming pregnant. With the help of the "usual" fertility therapies: Depending on the physical findings of both partners, either one comes for this insemination in question, in which the partner's prepared sperm is inserted into the uterus by the doctor. Or one In vitro fertilization, In other words, a conception in a test tube with subsequent transport of the fertilized egg into the uterus. Or something called a ICSI - this is a retort production in which the sperm cell is injected into the egg with a syringe.
Medicine now knows many possibilities; women with endometriosis do not need to give up hope of having a baby.

additional Information

Endometriosis Association Germany e.V.
Association of those affected who want to inform and advise.

European Endometriosis League
Association founded by medical professionals who want to spread knowledge about endometriosis and anchor the disease more firmly in the minds of doctors and the general public. Here you can z. For example, print out a checklist for a visit to the doctor.