For women facing issues with fertility, undergoing assisted reproductive therapy (ART) can be a gruelling and difficult process.
This is further complicated for those with endometriosis, with a recent study highlighting the importance of diagnosis for women undergoing ART. The University of Queensland study looked at whether ART was more successful for women with and without endometriosis. While the good news is that having endometriosis does not harm your chances of success with ART, this is only true for women who know their diagnosis prior to beginning treatment. Improving diagnosis is the key to improving ART success for women with endometriosis.
Lead researcher, Dr Katrina Moss, is motivated by her own personal experience with ART. Her personal struggle with endometriosis, led to her undergoing 3 surgeries for the condition, and 12 cycles of fertility treatment which were ultimately unsuccessful. Her hope is now that her research can help other women affected.
Endometriosis has historically been under-recognised and under-diagnosed in Australia, yet it affects one in nine women. The condition causes tissue similar to that lining the uterus to grow outside of the uterus. It can cause significant pain for those affected, as well as lead to issues with fertility.
Approximately 40% of women with endometriosis use fertility treatment to have a baby and one third of these women start treatment with undiagnosed endometriosis. Compared to women with diagnosed endometriosis, those undiagnosed are 33% less likely to have a baby and undergo more cycles of ART.
One of the biggest predictors of ART success is the age when a woman begins treatment. This means that any time wasted on inappropriate treatment decreases a women’s chance of a live birth. Currently, most women begin fertility treatment with Intrauterine Insemination (IUI), which is less invasive than In vitro fertilization (IVF). But for women with endometriosis, this is unlikely to be successful. IVF is the best treatment for those with endometriosis compared to other forms of fertility treatment. The new study showed that of those with a late diagnosis of endometriosis, 89% started with IUI and then ended up using IVF.
The mental and physical toll of ART also needs to be considered. Without diagnosis of endometriosis women are undergoing procedures that are unlikely to be successful for them, which Dr Moss explains is very unhelpful and can cause unneeded distress.
What should you do if you are undergoing ART and suspect you may have endometriosis?
Unfortunately, due to the lack of research into endometriosis until recently, there is still not a good early detection system for endometriosis. The current gold standard for diagnosis and treatment is laparoscopy, which is invasive and can also harm a woman’s response to ART. This means that routine screening for all women undergoing fertility treatment is not the answer as only one third of women undergoing fertility treatment have endometriosis. A less invasive diagnostic clinical interview is likely more helpful. This will include information about symptoms of endometriosis such as heavy or irregular periods, period pain and back pain. However, not all women who have endometriosis experience symptoms.
The best way forward if you suspect you may be affected is to talk to your specialist about less invasive screening methods. In particular, if you have symptoms or a family history you should discuss this with your treating specialist. There is also the option for those in doubt to start treatment with IVF instead of IUI, although there are associated costs with this.
Dr Moss’s personal experience has acted as a catalyst, motivating her to try to use her own journey to make things better for other women. She hopes her research will help women to know their pain is important, they need to be listened to, and they deserve the treatment that is right for them.
With a large number of women clearly not being diagnosed or receiving late diagnosis, it is important that individuals advocate for themselves within the healthcare system. To do this, they need the right information. This research will enable women to stay informed and take the correct information to their doctors.
Overall, early diagnosis of endometriosis is the key to better outcomes for women, not only in relation to fertility but for overall improvements to health and wellbeing. If you are experiencing issues with fertility, and suspect that you may have endometriosis, the best course of action is to speak to your specialist about the best options for you. Dr Moss encourages women to stay informed, advocate for yourself and know that you are not alone.