Understanding endometriosis and its impact on fertility

Fertility specialist Oluyemisi Famuyiwa MD, FACOG recently appeared on The Podcast by KevinMD to discuss a condition that affects millions of women worldwide: endometriosis. In her latest article, she sheds light on this often-misunderstood health care challenge, exploring its implications for fertility and offering insights into diagnosis, treatment, and emerging therapies. With endometriosis impacting up to 10 percent of reproductive-age women and potentially 50 percent of those struggling with infertility, Oluyemisi’s expertise provides a vital resource for women seeking answers. Her conversation offers a deep dive into what every woman should know about this condition and its far-reaching effects.

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What is endometriosis?

To begin, Oluyemisi explains the basics of endometriosis. Normally, during a menstrual cycle, the uterine lining sheds and exits the body as menstrual fluid. However, with endometriosis, this tissue behaves abnormally. Instead of leaving the body, it may flow backward or appear in unexpected places—on the ovaries, within the uterine muscle, across pelvic tissue, or even in rare cases, the lungs. Oluyemisi describes it as “endometrial tissue that’s not behaving the way it should be,” highlighting how this misplacement sets the stage for a range of complications.

How endometriosis presents in patients

Diagnosing endometriosis can be tricky, Oluyemisi notes. It often manifests as painful periods, a symptom many women experience for years before receiving a proper diagnosis. This delay—sometimes six years or more—stems from the condition’s subtlety. Health care providers might initially attribute the pain to a ruptured cyst or severe cramps, missing the underlying issue. Oluyemisi emphasizes that it affects about 10 percent of women of reproductive age and up to 50 percent of infertile patients, underscoring its prevalence and the need for awareness.

The link between endometriosis and infertility

So, how does endometriosis disrupt fertility? Oluyemisi explains that the misplaced tissue triggers inflammation by releasing cytokines—think of it as “putting jalapeño pepper inside your belly.” This inflammatory response can cause tissues to stick together, creating physical barriers to conception. The severity varies: some women with minimal endometriosis experience intense symptoms, while others with extensive cases remain unaware until it’s discovered incidentally during surgery or imaging. When the condition affects the ovaries, it can form “chocolate cysts,” which expand internally and may go unnoticed until later stages, further complicating fertility.

Risk factors for developing endometriosis

What puts someone at risk? Oluyemisi points to a mix of factors. Genetics may play a role—nature and nurture both contribute. Emerging studies also suggest that extreme stress could heighten susceptibility, though no single cause has been pinpointed. “I don’t think we have the one goal thing that says, here, this is what causes endometriosis,” she says, reflecting the condition’s complexity and the ongoing research needed to unravel it.

Impact on egg quality

Beyond physical obstruction, endometriosis affects egg quality. Oluyemisi describes how cysts in the ovary exert pressure on surrounding eggs, while the inflammatory cytokines induce oxidative stress. This dual assault compromises egg health, making conception more challenging. For women pursuing fertility treatments, understanding this impact is critical to tailoring effective strategies.

Tailoring fertility treatments for endometriosis patients

When a patient with endometriosis seeks fertility help, Oluyemisi’s approach hinges on the condition’s specifics. Was it diagnosed in the uterine muscle (adenomyosis), the ovaries, or the pelvic cavity? For mild cases confined to the peritoneal cavity, intrauterine insemination might suffice. More extensive cases often require in vitro fertilization (IVF) to retrieve and fertilize eggs outside the body. The extent and location of the endometriosis guide her recommendations, ensuring a personalized plan.

Considerations for infertile patients with endometriosis

For those with both infertility and a history of endometriosis, Oluyemisi stresses the importance of initial treatment. Was it fully excised during surgery, or merely cauterized and left in place? Complete removal delays recurrence by up to five years, buying time for pregnancy attempts or fertility preservation. Medications like GnRH antagonists (e.g., Lupron or the oral Aurelisa) can also suppress recurrence. She cites a colleague’s mantra: “I prefer to see you first before you get surgery done halfway,” underscoring the value of thorough initial intervention.

General treatment options

Beyond surgery, Oluyemisi outlines other approaches. Hormonal suppression with GnRH agonists or antagonists helps, though long-term use risks bone loss. Continuous low-dose birth control pills or progesterone-releasing IUDs like Mirena offer alternatives, providing sustained relief for some. She recalls a patient whose endometrioma regrew within four months of surgery because no follow-up suppression was prescribed—a reminder of the need for comprehensive care.

Lifestyle and dietary adjustments

Patients can also take proactive steps. Oluyemisi highlights endometriosis’s inflammatory nature, suggesting an anti-inflammatory lifestyle. Ongoing trials explore whether a Mediterranean diet—rich in vegetables, fruits, and low-inflammatory foods—improves outcomes. She advises avoiding excess alcohol and smoking, advocating for a holistic approach akin to that recommended for heart health or Alzheimer’s prevention. “Watching what comes in contact with your body” is key, she says.

Emerging treatments on the horizon

Looking ahead, Oluyemisi is excited about experimental therapies. Stem cell therapy and immunotherapy, though still in trials, show promise. Researchers are investigating biomarkers for earlier diagnosis, possibly via blood or menstrual fluid. Other targets include angiogenesis inhibitors to disrupt the blood supply to lesions and HDAC inhibitors to alter DNA methylation in aberrant tissue. These approaches, borrowed from cancer treatments, hint at a future where endometriosis might be managed more effectively.

Success rates for pregnancy

How successful are women with endometriosis in conceiving? Oluyemisi believes outcomes are strong with proper management. She shares a case of a breast cancer patient with a nine-centimeter ovarian cyst. After decompression and coordinated care, 13 eggs were retrieved despite initial bleak prospects. “With adequate, prompt management—the correct management—the success is very good,” she asserts, contrasting this with cases derailed by inappropriate treatments like high-dose estrogen pills.

Key takeaways for women

Oluyemisi’s parting advice is empowering: advocate for yourself. If cyclic pain or recurring issues like cyst ruptures persist, request an ultrasound or pelvic MRI. Physicians, in turn, should investigate repeated complaints. “Let’s look into this just in case something else is going on,” she urges, emphasizing proactive health care engagement. Her insights equip women to navigate endometriosis with knowledge and confidence.