Medically reviewed by Norbert Gleicher, MD, FACOG, FACS - Written by CHR Staff - Updated on Nov 15, 2014
Endometriosis & Infertility
"Even though endometriosis affects fertility, most patients can still conceive with IVF."
Whether or not so-called "mild" endometriosis affects fertility has remained controversial. At CHR, we strongly believe that endometriosis, even when mild, can negatively affect fertility. Even more importantly, endometriosis affects fertility adversely in many different ways, though its effects on normal tubal function appear to be the most important.
Investigations attempting to explain why patients with endometriosis often suffer from infertility have suggested that:
- Their fallopian tubes may function abnormally, due to adhesion or scarring resulting from endometriosis invading the tubes (so-called tubal infertility)
- Ovarian function may be adversely affected when endometriosis lesions invade the ovaries, possibly resulting in diminished ovarian reserve and sub-par egg quality
- Endometriosis may release toxic substances which may harm embryos and/or their implantation capacity
- Patients with endometriosis may be at a higher risk for miscarriages, lowering their live birth chances
Finally, there may be an immunological factor involved in endometriosis. Norbert Gleicher, MD, CHR's Medical Director and Chief Scientist, was the first to report on the possible association of autoimmunity and endometriosis, suggesting that endometriosis, indeed, may be an autoimmune disease. It is now widely accepted that the immune system, indeed, plays an important role in endometriosis-associated infertility
How Does Endometriosis Affect IVF Success Rates?
Endometriosis appears to affect IVF adversely, from reducing the number of eggs at the time of retrieval to poorer egg quality, and lower implantation and pregnancy rates. However, most endometriosis patients will still be able to conceive with IVF.
Can "Unexplained Infertility" Be Endometriosis?
Endometriosis often initially presents as "unexplained infertility," a diagnosis CHR does not believe in. Many studies in the literature point to similar patient characteristics in women with endometriosis and women with unexplained infertility. They also present with similar immune profiles.
In most cases of the so-called "unexplained infertility," we can pinpoint a real cause of infertility by performing appropriate diagnostic tests, even though correct diagnosis of endometriosis can be difficult. Correct diagnosis, of course, is the first step toward successful fertility treatment planning.
Norbert Gleicher, MD, FACOG, FACS
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.