How Endometriosis and Fibroids Contribute to Infertility in Women

Approximately 26 million people in India are affected by endometriosis, with 34-48% diagnosed through laparoscopy. The peak age for endometriosis is 25-35 years, and common symptoms include pelvic pain, dysmenorrhea, and infertility. The incidence of endometriosis among infertile women ranges from 20-50%. 

Around 37% of Indian women aged 20-40 and 57% of those aged 40-59 experience fibroids. Infertility is a challenging and emotional journey for many women, often stemming from various medical conditions that affect the reproductive system. Two common yet significant conditions contributing to female infertility are endometriosis and fibroids. Understanding how these conditions affect fertility is crucial for seeking appropriate treatment and improving the chances of conception. 

So, let’s understand endometriosis and uterine fibroids, their effects on your health, the symptoms you should look out for, and the treatment options that are there to help you in case you have these conditions. With timely diagnosis and the right medical treatment, it is possible to treat endometriosis and uterine fibroids and preserve your fertility.

Understanding Endometriosis

Endometriosis is a condition in which tissue resembling the uterine lining grows outside the uterus, typically on the ovaries, fallopian tubes, and other pelvic structures. This tissue thickens, breaks down, and bleeds during each menstrual cycle. Since it can't leave the body, it gets trapped, causing inflammation, pain, and scar tissue to form.

How Endometriosis Affects Female Fertility

Endometriosis can greatly affect a woman's fertility in several ways. Here’s how this condition affects different parts of the reproductive system:

• Endometriosis can create scar tissue and adhesions that block or damage the fallopian tubes. This prevents the egg and sperm from meeting, making fertilisation impossible. Even if the tubes are partially blocked, it can still make it difficult for the egg and sperm to travel and meet.
   
• Endometriosis can lead to the formation of cysts called endometriomas on the ovaries, which can affect fertility by lowering the quality of the eggs, making fertilisation less likely. These cysts can disrupt normal ovulation, making it harder for the ovaries to release a healthy egg. Furthermore, surgery to remove endometriomas can also remove healthy ovarian tissue, reducing the number of eggs available for fertilisation.
   
• The inflammation and scar tissue from endometriosis can create a hostile environment in the pelvis. Chronic inflammation can damage reproductive organs and tissues, making fertilisation and embryo implantation difficult. Adhesions and scar tissue can alter the structure and function of the pelvic organs, hindering the movement of the egg and sperm. Additionally, endometriosis can cause fluid buildup in the pelvis, interfering with sperm function and egg fertilisation.
   
• Endometriosis can trigger an abnormal immune response that negatively impacts fertility. The immune system may mistakenly target and attack sperm, reducing their ability to fertilise an egg. This immune response can disrupt embryo implantation in the uterus, leading to implantation failure or early pregnancy loss. Moreover, endometriosis can cause an imbalance of cytokines (cell signalling proteins), affecting the communication between cells necessary for successful fertilisation and implantation.

These are some of the most important ways endometriosis can affect fertility in women. All the risks mentioned above are mostly caused by cases of late diagnosis. It is extremely important to be mindful of certain symptoms that you need to monitor to diagnose these problems quickly. The symptoms and other risk factors that you need to monitor are mentioned ahead in the article. But first, let’s understand uterine fibroids and their impact on women’s health and fertility.

Understanding Fibroids

Fibroids are benign growths that form in or on the uterus. They can range in size from very small to quite large and may be few or many. The location of fibroids affects their impact:

• Submucosal Fibroids: These develop within the uterine cavity, just below the lining. They can change the shape of the uterus, causing heavy menstrual bleeding and fertility problems by making it hard for an embryo to implant.
   
• Intramural Fibroids: These are the most common type, growing inside the muscular wall of the uterus. They can cause the uterus to expand, leading to heavy periods, pelvic pain, and pressure. They can also interfere with the uterus's normal function, affecting fertility.
   
• Subserosal Fibroids: These develop on the outer surface of the uterus. They can get quite large and press on nearby organs like the bladder or bowel, causing discomfort. While they usually don't affect menstrual flow directly, large ones can still impact fertility.

Fibroids develop due to hormonal factors, especially estrogen and progesterone. They tend to grow during a woman's reproductive years and often shrink after menopause when hormone levels drop. While the exact cause that leads to the development of fibroids is unknown, genetics, hormones, and environmental factors may contribute.

How Fibroids Affect Fertility

Fibroids can significantly impact a woman's fertility in several ways. Here’s how this condition affects different parts of the reproductive system:

Submucosal fibroids can distort the shape of the uterine cavity, making it difficult for the embryo to implant. The altered shape of the uterus can prevent the embryo from finding a suitable spot to attach and grow, reducing the chances of a successful pregnancy.

Large fibroids can block the fallopian tubes, stopping sperm from reaching the egg. This blockage can stop fertilisation from occurring, making conception difficult or impossible.

Fibroids can affect blood flow to the uterine lining, reducing the chances of successful implantation and pregnancy. Poor blood flow can make it harder for the uterine lining to support the embryo, leading to implantation failure.

Fibroids can cause chronic inflammation, creating an unfavourable environment for conception and pregnancy. The persistent inflammation can damage reproductive tissues and disrupt the normal processes needed for a successful pregnancy.

Symptoms & Diagnosis For Endometriosis And Uterine Fibroids

Endometriosis and fibroids can cause various symptoms that affect daily life and reproductive health. Common symptoms of endometriosis include:

• Pelvic pain
• Painful menstruation
• Pain during sex
• Heavy menstrual bleeding 
• Infertility

Symptoms that are commonly caused by uterine fibroids include:

• Heavy periods 
• Pelvic pain
• Frequent urination
• Constipation
• Infertility

There are other risk factors for endometriosis and uterine fibroids including never being pregnant or giving birth, obesity, age, underlying chronic health conditions like high blood pressure, family history, and vitamin D deficiency. If you have these risk factors, it is important to discuss them with your gynaecologist during your reproductive years to mitigate any risk of fibroids or endometriosis you may have.

Diagnosing these conditions usually involves pelvic exams and imaging tests like ultrasounds or MRIs. Sometimes, diagnosing endometriosis may also require a laparoscopy, a minor surgical procedure to view and take samples of the pelvic organs.

Treatment Options

Managing endometriosis and fibroids often requires a combination of medical and surgical treatments. For endometriosis, medications like pain relievers and hormonal therapies, including birth control pills and drugs that reduce hormone levels, can help control symptoms and slow the growth of endometrial tissue. In some cases, surgery is needed to remove endometriotic tissue, cysts, and scar tissue using a minimally invasive procedure called laparoscopy.

For fibroids, treatment also includes both medications and surgery. Hormonal treatments and nonsteroidal anti-inflammatory drugs (NSAIDs) can help shrink fibroids and relieve pain. In more severe cases, surgical options like myomectomy (removal of fibroids while preserving the uterus) or uterine artery embolisation (cutting off the blood supply to fibroids) may be used. In extreme cases, a hysterectomy or removal of the uterus is required.

Conclusion

Endometriosis and fibroids are significant contributors to female infertility, but with early diagnosis and appropriate treatment, many women can improve their fertility and achieve successful pregnancies. If you experience symptoms related to these conditions or have relevant risk factors, get in touch with our specialists at MASSH today. We can help you with low-risk and quick recovery minimally invasive surgical treatments for conditions like endometriosis and uterine fibroids. Check out our website to learn more about minimally invasive surgeries at MASSH and request a call back today.