About Infertility

Infertility

Studies show that approximately 70% of women suffering from endometriosis are fertile and can conceive spontaneously. However, endometriosis should be suspected in women who wish to have children but are unable to become pregnant naturally after at least one year.

Regarding this percentage of infertility, patients with endometriosis who want children have several available options, such as:

• Spontaneous conception;
• Surgical intervention to remove endometriotic lesions. Studies have shown that surgical treatment (when necessary) increases the chances of achieving a spontaneous pregnancy, especially in patients with peritoneal endometriosis;
• Artificial insemination;
• In Vitro Fertilization.

REQUIRED MEDICAL TESTS:

• Evaluation of Ovarian Reserve:
  • Anti-Müllerian Hormone (AMH)
  • Measurement of FSH and estradiol levels on day 3 of the menstrual cycle
  • Clomiphene citrate challenge test
  • Ultrasound assessment of antral follicle count
• Evaluation of Fallopian Tubes:
  • Hysterosalpingography – checks the patency of the fallopian tubes
  • Exploratory laparoscopy
  • Tests for vaginal discharge, cervical cultures, antibodies for Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Neisseria gonorrhoeae
• Evaluation of the Uterine Cavity:
  • Saline infusion sonohysterography
  • Three-dimensional ultrasonography
  • Hysterosalpingography
  • Hysteroscopy
• Tests with Limited Clinical Utility:
  • Postcoital test
  • Endometrial biopsy
  • Basal body temperature charting
• Sperm analysis

Some of these tests and procedures will be recommended by the physician based on the patient’s age, clinical examination, and medical history, following a well-established diagnostic algorithm.

Specialized literature data has highlighted that patients suffering from endometriosis have a higher risk of miscarriage if no treatment is provided. Compared to control groups, patients with endometriosis show an increased incidence of spontaneous miscarriage (25%).

So far, there have been no reported cases where hormonal treatment administered before or after surgery has increased fertility rates in patients with endometriosis.

ARTIFICIAL INSEMINATION

Assisted reproductive techniques such as artificial insemination (procedures by which the partner’s semen is injected into the uterus at ovulation) can be especially recommended in early and moderate stages of endometriosis. The physician may suggest controlled ovarian stimulation to increase the chances of achieving pregnancy. Also, if ovarian stimulation is performed within six months after surgery, the chances of becoming pregnant are significantly higher.

At the same time, artificial insemination cannot be performed if the fallopian tubes are not patent, are blocked, or if the partner has fertility issues.

OTHER ASSISTED REPRODUCTIVE TECHNOLOGIES

Women suffering from endometriosis may opt for various assisted reproductive techniques. These involve collecting the semen and the egg, which are then combined and fertilized. After fertilization, the fertilized egg or embryo is transferred to the uterus.

• In Vitro Fertilization (IVF) – this procedure involves hormonal stimulation of the follicles before retrieving the mature egg. The egg is collected through ultrasound-guided puncture. The semen and egg are then processed in the lab and transferred into the uterus 3–5 days after collection and fertilization at the embryo stage.
• Intracytoplasmic sperm injection (ICSI) – this is a procedure similar to IVF, with the distinction that a single sperm is injected directly into the egg, unlike the previous technique where the egg was placed in a dish with multiple sperm. This method is particularly indicated when the semen quality is lower.