Will endometriosis reduce my chances of falling pregnant?

Q. My doctor said I might have endometriosis and that my tubes are damaged. Will I be able to fall pregnant?

A. Endometriosis is often first diagnosed in those seeking treatment for infertility. Because endometriosis causes higher levels of inflammation, it can lead to damage of the ovaries, and fewer eggs being produced at ovulation and therefore available for fertilisation.  

When the ovary produces the eggs, for pregnancy to occur, the ovum (the egg) has to migrate from the ovary, through the fallopian tube, where fertilisation can occur, before further migration to the uterus for implanting into the lining. In those with endometriosis affecting the fallopian tube lining, the endometrial tissue may keep the egg from travelling to the uterus.

It is advisable to consult a fertility specialist to assess the baseline and if possible discuss the current and long-term prospects of becoming pregnant. A blood test such as an anti-mullerian hormone test can be used as a guide to the egg supply or "ovarian reserve".

The only way to truly diagnose endometriosis is surgery to identify areas where the endometrium is present, outside of the normal area, the uterus. In some cases surgery can help to remove growths in order to improve chances of pregnancy.

The severity of endometriosis will guide your options, which may include:

• Freezing your eggs, which can be costly, and is not covered by medical insurance. It preserves eggs in case you wish to try to become pregnant later;
• Assisted insemination for those who have normal fallopian tubes and mild endometriosis, and whose partner has good-quality sperm;
• Fertility medications to help the ovaries produce mature eggs, at which time the partner's sperm is inserted; and
• In vitro fertilisation, when the egg is extracted, fertilised with sperm outside the body and implanted back into the uterus.

Some people, after many years of trying, are able to get pregnant and carry to term.

You may benefit from experimenting in different ways to enhance pleasure, get your mind off the scheduled sex and lack of spontaneity being on a fertility programme can bring. Although you may feel like sex is a chore, dedicate more time to foreplay and try not worry about the fact that pregnancy is the desired outcome. The focus on pleasure and intimacy help to de-stress the situation.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za.

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