Endometriosis: A Common Cause of Infertility
At Cape Fertility, we passionately support Endometriosis Awareness Month each March, and this year, we highlight an important but little-known fact: endometriosis is a common cause of infertility.
At Cape Fertility, the majority of female infertility cases we treat are linked to four main causes: endometriosis, fibroids, tubal disease, and polycystic ovarian syndrome (PCOS).
In support of Endometriosis Awareness Month, we take a closer look at endometriosis in this article: who is affected, what it is, what causes it, what symptoms it produces – specifically infertility – as well as when to seek help from a fertility specialist.
Who is Affected by Endometriosis?
Endometriosis is a widespread condition, affecting approximately 10% of women worldwide.
The condition can begin at any age, affecting teenagers, women in their 20s and 30s, and even those in their 40s.
Women who are diagnosed at a younger age often have more severe cases of endometriosis. Unfortunately, because endometriosis affects women during their most fertile years, it can be a significant barrier to conceiving naturally.
What Is Endometriosis?
Endometriosis is a benign condition, meaning it is not cancerous. However, it can have a significant impact on a woman’s fertility and quality of life. The condition occurs when tissue similar to the lining of the uterus (endometrium) grows outside the uterus, in areas where it should not be.
This misplaced tissue can grow on the ovaries, fallopian tubes, and the outer surface of the uterus, and in more severe cases, on other organs such as the bladder or intestines.
Because this tissue responds to hormonal changes just like the uterine lining, it thickens and bleeds during each menstrual cycle. However, unlike the normal uterine lining, this misplaced tissue has no way to exit the body, leading to inflammation, scarring, and adhesions that can impact fertility.
How Is Endometriosis Classified?
The American Society for Reproductive Medicine (ASRM) has classified endometriosis into four stages, based on the extent of the disease:
• Stage I – Minimal: Few small implants and little to no scar tissue.
• Stage II – Mild: More implants and mild adhesions.
• Stage III – Moderate: Presence of larger endometriomas (chocolate cysts) and more extensive scar tissue.
• Stage IV – Severe: Large cysts and widespread adhesions, often affecting multiple organs.
It is important to note that the severity of endometriosis does not always correlate with the level of pain or infertility a woman experiences. A woman with minimal endometriosis may have severe pain and fertility challenges, while someone with severe endometriosis may have no symptoms at all.
However, stage IV endometriosis is strongly linked to infertility.
What Causes Endometriosis?
Despite extensive research, the exact cause of endometriosis remains unknown. However, several theories exist:
• Retrograde menstruation: instead of exiting the body, menstrual blood flows backward through the fallopian tubes into the pelvis, depositing endometrial cells where they don’t belong.
• Immune system deficiencies: a compromised immune system may fail to clear these misplaced cells.
• Environmental factors: exposure to toxins may influence the development of endometriosis.
• Genetics: studies suggest that endometriosis may run in families.
While the cause of endometriosis is not fully understood, what is clear is that early diagnosis and treatment can help manage its effects—especially for women struggling with infertility.
What Are the Symptoms of Endometriosis?
The most common symptoms of endometriosis include:
1. Chronic Pelvic Pain
Pain in the pelvic area—especially during menstruation—is one of the most recognizable symptoms of endometriosis. In fact, for many women experiencing chronic pelvic pain, the cause is undetected endometriosis.
2. Painful Periods
Many women with endometriosis experience extremely painful menstrual cramps that do not improve with typical pain relief medications.
3. Pain During or After Intercourse
Pain during or after sex is a common sign of endometriosis, often caused by deep lesions near the vagina or lower pelvis.
4. Pain During Bowel Movements or Urination
Women with severe endometriosis may experience discomfort while using the bathroom, particularly during menstruation.
5. Infertility
One of the most serious symptoms of endometriosis is difficulty conceiving.
Between 25% and 40% of women struggling with infertility have endometriosis. The condition can create inflammation and scar tissue, leading to blockages in the fallopian tubes, making it difficult for the egg and sperm to meet.
Other symptoms of endometriosis may include fatigue, depression, digestive issues, and bloating.
Endometriosis Is Often Misdiagnosed!
A major challenge with endometriosis is the delay in diagnosis. On average, it takes seven years for a woman to receive a correct diagnosis!
This delay occurs because symptoms can be mistaken for:
• Normal menstrual pain
• Irritable Bowel Syndrome (IBS)
• Pelvic inflammatory disease (PID)
The key to early diagnosis is awareness. If you suspect endometriosis, consulting a specialist is crucial—especially if you are trying to conceive.
How Is Endometriosis Diagnosed?
There are several ways to confirm an endometriosis diagnosis:
1. Medical History & Symptoms: a doctor may suspect endometriosis based on symptoms such as chronic pelvic pain and painful periods.
2. Ultrasound Examination: advanced ultrasound technology allows specialists to detect signs of endometriosis, such as ovarian cysts and adhesions.
3. Laparoscopy: this minimally invasive surgery allows specialists to visually inspect the uterus, ovaries, and fallopian tubes for endometriosis lesions.
Laparoscopy also offers the advantage of treatment—doctors can remove endometriosis tissue and adhesions during the procedure, improving fertility outcomes.
What Should I Do If I Suspect I Have Endometriosis?
If you are experiencing difficulty conceiving along with painful periods and severe pelvic pain, the best course of action is to seek professional advice from a fertility specialist.
There are many medical management strategies to treat endometriosis so it doesn’t mean that you will have surgery if diagnosed. The earlier you treat, the better, as then you may not require fertility treatment when you are trying to conceive.
At Cape Fertility, we offer comprehensive endometriosis treatment options, along with advanced fertility treatments such as:
• In Vitro Fertilization (IVF)
• Intrauterine Insemination (IUI)
• Egg Freezing & Fertility Preservation
• Minimally Invasive Surgery
Endometriosis can be challenging, but with the right treatment plan, many women can manage their symptoms and also successfully conceive.
Take the First Step Today!
If you suspect that you have endometriosis—especially if you are trying to conceive—we invite you to speak with one of our specialists at Cape Fertility by simply clicking here…
At Cape Fertility, we value each individual patient and we look forward to providing you with individualised and personalised care, affordable quality fertility treatment, and higher success rates at our purpose-built premises in the beautiful city of Cape Town.