Infertility can be a heartbreaking topic for individuals with endometriosis. Some are diagnosed young and fear that if they wait too long, they will lose their chance to start a family. Others have tried for years without success. Some have been able to bring a baby into this world but not without loss and pain. Still, others are given hysterectomies before they had a chance. It is a heartbreaking burden many carry in silents. Actually, The American Society for Reproductive Medicine quotes that endometriosis is found in 50% of women experiencing infertility. This makes endometriosis one of the two leading causes of infertility in the US.
“Endometriosis is found in 50% of women experiencing infertility” – The American Society for Reproductive Medicine
How Does Endo Effect Fertility?
Unfortunately it seems that endo has effects of fertility in more the one way.
- Scar Tissue/Blockage: Endometriosis can form on and damage the ovaries and fallopian tubes. This can prevent sperm from fertilizing the egg. This can also block the fertilized egg (embryo) from passing through the fallopian tubes to the uterus where it can implant and grown.
- Inhospitable Environment for Sperm: Individuals with endometriosis have elevated inflamatory cytokines (especially in the pelvis). These cytokines (namely IL-6 & TNF-α) can be spermicidal (damaging to sperm cells) by slowing their motility (movement) and having ill effects on their physological functions.
- Stealing Stem Cells: Bone marrow stems cells can be thought of a baby cells that can grow up to be multiple things. In a “normal” patient some of these stem cells go to the uterus to aid in uterine repair and endometrium (lining of the uterus) formation. This process creates a hospitable environment for the impanation of a fertilized embryo. It has recently been found that CXCL12 (a cytokine some times refered to as SDF1) is a chemotaxic agent (meaning it aids in the process of cellular movement). It is produced by endometrium to attract more stem cells for repair and regrowth. Endometriosis lesions have been found to also produce CXCL12 but at much higher levels then the health endometrium. There are a limited number for bone marrow-derived stem cells that can develop into endometrial tissue. So when endometriosis starts attracting all the avalible stem cells it is essentially stealing them from the uterous. This can cause poor endometrium quality leading to lower chances of proper embryo implantation which is needed for a healthy pregnancy.
- Poor follicular quality: Each month an oocyte grows on your ovary. An oocyte is the folical conating egg, ova, & ovum. For pregnancy to accure this folical must go through a process of growth and division and eventually lead to implantion in the uterous. This is a process called folliculogenesis. There have been muliple studies indicating imparments of folliculogenesis in individuals with endometriosis. Some of these impairments include slower growth rates and lower fertilization success of the follicals. The reason for impaired folliculogenisis is multifactoral not completely understood. Some factors that may cause alterations to folliculogenesis include oxidating stress, decreased vascular endothelial growth factor (VEGF), and increased inflamatory factors resulting in low-quality oocytes
“We like to think of the endometriosis as a stem cell sponge. It competes with the uterus for this limited supply of stem cells that are important for uterine repair.” – Dr. Hugh Taylor
Not All Hope Is Lost!!!
Even though endometriosis can cause infertility it is vital to remember this is not always the case!! According to a 2010 study published in the Journal of Assisted Reproduction and Genetics 50%-60% of patients with endometriosis a fertile without medical assitance such as IVF. When you consider individuals who able to conceive and carry a healthy pregnancy via fertility assistance those percentages rise even further. We recommend talking to your doctor about your current and future options for fertility and what measures can be taken now to perserve future fertility. These methods may include the following:
Methods that Can Aid in Fertility for Patients with Endometriosis:
- In-vitro fertilization (IVF)
- Embryo transfer (ET) & Serogates
- Intrauterine Insemination (IUI)
- Supplemental Hormone Therapies
- Tubal Ligation
Gupta, S., Goldberg, J. M., Aziz, N., Goldberg, E., Krajcir, N., & Agarwal, A. (2008). Pathogenic mechanisms in endometriosis-associated infertility. Fertility and Sterility,90(2), 247-257. doi:10.1016/j.fertnstert.2008.02.093
Bulletti, C., Flamigni, C., & Ziegler, D. D. (2005). Implantation markers and endometriosis. Reproductive BioMedicine Online,11(4), 464-468. doi:10.1016/s1472-6483(10)61142-x
Taylor, H., MD. (2016, April 19). Endometriosis and stem cells. Lecture presented at Scientific Symposium Advancing the Science and Surgery of Endometriosis in The Union Club, New York.
Thanks for your blog, nice to read. Do not stop.