Endometriosis & the desire to have children
and Martina Feichter, medical editor and biologistMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
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Unfortunately, for many women with endometriosis, the desire to have children remains unfulfilled: More than half of all patients cannot become pregnant spontaneously. The best treatment in this case is surgery, experts say. Surgical removal of the endometriosis focus can improve fertility in many women. Read everything you need to know about endometriosis & the desire to have children and in which cases artificial insemination is recommended!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. N80D39
Endometriosis: reasons for an unfulfilled desire to have children
Endometriosis and infertility often go hand in hand: more than half of all women with endometriosis have trouble getting pregnant. Conversely, the disease is found in more than 50 percent of all women with an unfulfilled desire to have children.
The causal connection between endometriosis and infertility has not yet been clarified in detail. One thing is certain: Endometriosis can cause sticking and adhesions of the fallopian tubes and ovaries, which can represent a "mechanical" obstacle to pregnancy.
It is unclear whether the endometriosis foci - which are a foreign body to the organism (uterine lining in the wrong place) - call the immune system on the scene in such a way that this prevents a fertilized egg cell from implanting. It is also not clear whether the endometriosis affects the migration of sperm through the uterus and fallopian tubes, the mobility of the fallopian tubes and the maturation of the egg cells. However, there are indications that egg cell development and early embryonic development can be disturbed in endometriosis patients.
Notes: Endometriosis can be associated with infertility even if the disease does not cause any other symptoms!
Pregnant despite endometriosis - thanks to surgery
If women with endometriosis do not wish to have children, the endometriosis focus should be surgically removed, and as completely as possible. This can improve the chances of a spontaneous pregnancy, at least in the case of pronounced endometriosis. In milder cases, when the fallopian tubes and ovaries are not affected by growths of the uterine lining, it is not certain whether an operation can help: In such cases it is questionable whether the unfulfilled desire to have children is actually caused by the endometriosis.
An endometriosis operation is usually performed as a laparoscopy: the surgeon inserts an endoscope into the abdomen through a small incision in the abdominal wall. It's a thin tube with a small camera and a light source on top. Fine surgical instruments can be inserted through this tube, with the help of which endometriosis foci and cysts can be removed.
Endometriosis medications won't help
Endometriosis is sometimes treated with medication instead of surgery: hormone preparations with progestins or GnRH analogues can slow the growth of the endometriosis lesions and so relieve the pain of the disease. However, this purely medicinal endometriosis treatment has no effect on fertility.
The same applies to treatment with GnRH analogues after an endometriosis operation: the hormones are intended to calm any remaining endometriosis foci. So far, however, there is no evidence that the combination of surgery and hormone treatment is more effective than surgery alone: it does not help better against the pain of endometriosis, and the combination therapy does not make pregnancy any more likely. In addition, the hormone preparations can have unpleasant side effects (hot flashes, sleep disorders, mood swings, etc.). Experts therefore advise against postoperative GnRH treatment in endometriosis patients with infertility.
Endometriosis: artificial insemination
Especially in the case of pronounced endometriosis, new scattered mucous membrane islands often form after an operation (relapse = relapse). However, experts advise against further surgical intervention to improve fertility - especially if the woman has already had several such operations.Instead, they recommend artificial insemination for recurrent endometriosis. The desire to have children should be fulfilled with this rather than with further operations.
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