Could the pain in your pelvis affect your fertility?

Posted on 29 September 2017

Endometriosis – when the tissue that lines your womb is found elsewhere in your body – is a common gynaecologicial disorder that’s associated with fertility problems.

Up to half the number of women with endometriosis experience some degree of infertility, according to the Endometriosis Society of South Africa.

‘There is no definitive study establishing a clear cause and effect, but it is suggested that women who struggle to conceive are more predisposed to developing endometriosis, rather than endometriosis causing the infertility,’ says Dr Deon van Zyl, an obstetrician and gynaecologist at Mediclinic Panorama.

The good news is that, even with severe endometriosis, it’s still possible to fall pregnant. The key is to start discussing your conception options with your doctor, especially if you haven’t conceived after six months.

‘In most cases, it’s not understood why it’s harder for women with endometriosis to become pregnant,’ says Dr van Zyl. Some theories suggest that pelvic adhesions interfere with the movement of the egg down the fallopian tube or that pelvic inflammation caused by the disease stimulates the production of sperm-attacking cells.

‘In some cases though, endometriosis is severe enough to cause damage to the ovaries and/ or the fallopian tubes,’ Dr van Zyl adds. ’This can prevent or delay natural conception.’

So what can be done?

Although physical examinations, scans (ultrasound and MRI) and other tests are used to diagnose endometriosis, the only way to be 100 per cent sure you have the disease is if your doctor performs a laparoscopy (keyhole surgery). ‘The advantage of this procedure is that your diagnosis can be confirmed and treatment can often be carried out at the same time,’ says Dr van Zyl.

In mild to moderate cases of the disorder, your doctor will be able to remove endometriotic patches, implants, cysts, nodules and adhesions during a diagnostic-turned-operative laparoscopy.

These tissues will either be cut away from the surrounding tissue (excision) – or will be burnt (coagulation) with a very fine heat gun or laser beam.

‘However, if your endometriosis is severe, the operative laparoscopy may be delayed so you can be adequately prepared for surgery that might involve your bowel and urinary tract,’ Dr van Zyl adds.

‘Surgical removal of endometriosis — laparoscopic excision of disease — has been shown to improve fertility rates in women with endometriosis,’ he says. ‘But it’s important to remember that treatment for endometriosis associated with infertility needs to individualised for each patient. There are no easy one-size-fits-all solutions and treatment decisions depend on a number of factors including the severity of the disease, its location in the pelvis, the patient’s age and length of infertility.’

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In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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