A woman’s fertility depends on many factors, and some hormonal problems or diseases can significantly interfere with it. Endometriosis and polycystic ovary syndrome (PCOS) are some of the most common conditions that can make it difficult to get pregnant. In this article, we take a look at how these conditions affect a woman’s body and what diagnostics and treatments are available to help restore health balance.
What is endometriosis?
Endometriosis is a chronic condition in which tissue similar to that lining the uterus (endometrium) begins to grow outside the uterus – most commonly around the ovaries, fallopian tubes or pelvic peritoneum. The causes of endometriosis are not fully known, but it is thought that the disease may be the result of genetic factors, immune system disorders or the backflow of menstrual blood through the fallopian tubes (the so-called retrograde menstruation theory). This tissue, like the endometrium, reacts to hormonal changes during the menstrual cycle, resulting in local inflammation, pain and the formation of lesions (adhesions).
Effects on fertility
- Endometriosis can lead to damage to the structures of the fallopian tubes and ovaries.
- Adhesions and cysts (known as endometriomas) can interfere with the ovulation process and the transport of the egg into the fallopian tube.
- Inflammation associated with endometriosis can adversely affect the quality of the ova and the implantation of the embryo in the uterus.
- The disease has a significant impact on overall quality of life, and painful conditions can impede daily functioning, affecting emotional state and libido.
It is estimated that up to 30-50% of women with endometriosis may struggle to get pregnant.
What is PCOS?
Polycystic ovary syndrome (PCOS) is a hormonal disorder characterised by an excess of androgens (male hormones) and abnormal maturation of ovarian follicles and the characteristic appearance of the ovaries on ultrasound imaging. Significantly prolonged, irregular cycles, non-ovulatory cycles and the presence of multiple small cysts on ovarian imaging that impede normal ovulation are common. Patients may also experience additional symptoms, i.e. hirsutism, acne lesions, weight management problems, insulin resistance.
Effects on fertility
- PCOS often causes a lack of ovulation (non-ovulatory cycles), making it difficult to get pregnant.
- Hormonal disturbances can lead to irregular menstrual cycles or lack of cycles.
- Excess androgens can affect the quality of egg cells.
PCOS affects approximately 8-13% of women of reproductive age and is one of the most common causes of hormone-related infertility. Studies suggest that the prevalence of PCOS may vary by population, for example, it is higher among women of South Asian descent, which may be due to both genetic and environmental factors.
Diagnosis of endometriosis and PCOS
Diagnosis of endometriosis and PCOS requires a comprehensive approach, and early testing is key to improving prognosis and treatment efficacy. The primary diagnostic methods are:
- Medical history: Attention is paid to symptoms such as pelvic pain, irregular cycles or problems getting pregnant.
- Imaging tests: Transvaginal ultrasound helps to detect endometrial cysts and characteristic features of PCOS, such as enlarged ovaries with numerous follicles. In some cases, an additional NMR study may be considered in patients with suspected endometriosis.
- Hormonal tests: Help to assess levels of androgens, insulin and hormones that regulate the menstrual cycle. A marker often considered in the diagnosis of PCOS is AMH. High levels of AMH may be indicative of the disorder. There are attempts at molecular diagnosis of endometriosis, but the quality of the available tests does not yet allow a definite recommendation.
Treatment
The treatment of both conditions depends on their severity and plans for motherhood.
The following treatment may be applicable when trying for pregnancy:
Endometriosis:
Generally starts with ovulation stimulation depending on individual indications, age, ovarian reserve and patience and economic possibilities. Due to the current situation in Poland (free of charge in vitro treatments), it is quite soon worthwhile to use the in vitro fertilisation procedure as the most effective method.
PCOS:
Pharmacological efforts to get pregnant seem to be the optimal treatment in many cases. In this case, up to 6 cycles of stimulation can be offered if previously there were none. In vitro fertilisation should be considered for further management.
Both endometriosis and PCOS are not in themselves an indication for insemination. To determine whether this is a reasonable method, additional tests should be performed.
Endometriosis:
- Pharmacotherapy: Hormonal medications (e.g. gestagens, GnRH analogues) can reduce symptoms and inhibit disease progression.
- Surgery: In certain cases, when you are no longer planning to have children and pharmacological treatment does not relieve the pain, it may be advisable to remove the endometriosis foci and adhesions. The procedure should be preceded by a detailed benefit-risk analysis, as a complication may be a reduction in ovarian reserve.
PCOS:
- Lifestyle changes: diet and regular physical activity can improve insulin sensitivity and regulate menstrual cycles. In the case of PCOS, lifestyle often plays a very big role.
- Medications: Metformin (which improves glucose metabolism) and ovulation-stimulating drugs (e.g. clomiphene citrate) are used. During periods when a woman is not trying for a child, hormonal contraception is recommended, which significantly improves quality of life and eliminates most symptoms.
Summary
Endometriosis and PCOS significantly affect fertility, but with appropriate diagnosis and treatment, many women succeed in achieving their desired pregnancy. For patients with endometriosis, appropriate medication, surgery or in vitro fertilisation (IVF) may be the solution to achieving pregnancy. In contrast, in the case of PCOS, the introduction of lifestyle changes and pharmacological treatment, such as clomiphene citrate, has very good results in many women. The key is to consult an experienced doctor and choose a treatment tailored to the individual.
At the ARTVIMED clinic, patients are provided with comprehensive care – from diagnosis to advanced assisted reproduction methods. Don’t delay, trust the specialists and take a step towards realising your dreams of motherhood.