The lining inside the uterus womb is called the endometrium. Sometimes tissues that resemble the endometrium grow outside the womb. This condition is called endometriosis. The abnormal growths can occur in the bladder, bowel, fallopian tubes, ovaries or abdomen.

The symptoms tend to vary from person to person, ranging from painful, irregular or heavy periods, pain in the lower back, lower abdomen or pelvis around ovulation time, even throughout the menstrual cycle, persistent pelvic pain lasting over six months, pain after or during sex, difficulty getting pregnant, painful bowel and bladder movements, etc. Less common symptoms include bleeding from the back passage, fatigue and painful abdominal scars or pain around the belly button during periods. Some women, however, don’t experience any symptoms at all, which of course doesn’t determine the severity of their condition.

Yes, endometriosis can dent your chances of conceiving, as the inflammation could make it hard for the sperm and egg to rendezvous or an embryo to implant in the uterus. But, fortunately, most women with mild endometriosis can conceive. Research shows around 70% of females with moderate to mild endometriosis can conceive without treatment. However, even if you have endometriosis and are trying to have a baby without success, don’t lose heart. A visit to a fertility specialist or doctor could remove the roadblock without much fuss.

How to diagnose endometriosis?

Since the symptoms often mimic other conditions, endometriosis is often difficult to diagnose. The three common methods used for diagnosis are:

• Manual examination (palpating) areas in the pelvis and abdomen for abnormalities
• USG scan done through the abdomen or using a ‘wand’ inserted into the vagina (transvaginal ultrasound)
• Laparoscopy to look inside the abdomen for signs or location of endometriosis

Conception with endometriosis

If you have the condition and trying to conceive, you will first be asked to stop painkillers like NSAIDs since those can affect your baby if you succeed to conceive.

Surgery options

You might be advised laparoscopic or keyhole surgery to enhance fertility if you have mild or minimal endometriosis. In this procedure, a narrow tube with a camera attached to its end is inserted into the belly through a minor cut. Using this camera and sometimes a few more small incisions around the bikini line, scissors or laser/heat are passed to destroy/remove the tissue. While this is one of the most effective endometriosis treatment options, there is always a risk of some residual tissue remaining and re-growing, to trigger a recurrence. Another more invasive surgery is a laparotomy wherein wider cuts are made along the bikini line to remove the rogue tissue attached to the affected area. However, this surgery is only done in very few exceptions.

In the post-surgical procedure, the chances of conceiving naturally are best assessed by the EFI (endometriosis fertility index), which factors in issues like the period of infertility, age, extent of the disease and the involvement of the fallopian tube, history of pregnancy, etc.

Role of IVF in endometriosis

Outside the domain of the knife, ART (Assisted reproductive techniques) such as IVF (In-Vitro Fertilization) or IUI (Intrauterine Insemination) are proven treatments for infertility related to endometriosis. It is recommended that IVF should be offered if you have been trying to have a baby for two years with endometriosis but in vain, given that other critical factors like ovulation and semen quality are normal. Of course, the odds of success would always depend on the severity of endometriosis.

A large number of people with endometriosis have successfully got pregnant after turning to IVF treatments. The fertility specialist will also tell you how important it is to have a healthy lifestyle with proper diet and exercise when you are trying for a baby and have endometriosis. This can control inflammation and prepare the body better to help your baby grow and thrive throughout the pregnancy.