Many women who try to get pregnant for a prolonged period without success end up seeking medical attention and discover endometriosis, a condition that is not always initially perceived because most people only suspect it when they feel intense pain.
According to the Brazilian Society of Assisted Reproduction (SBRA), approximately 10% of people of reproductive age have endometriosis. This percentage increases significantly among those with reproductive difficulties, reaching up to 50%. However, it is important to note that not every woman diagnosed with the disease will have problems getting pregnant.
How endometriosis hinders pregnancy
Endometriosis occurs when tissue similar to the inner lining of the uterus proliferates in other parts of the body. This tissue responds to hormones monthly, just like the endometrium, but because it is in an inappropriate location, it causes inflammation around it.
This condition can interfere with pregnancy in four distinct ways:
- The fallopian tubes and ovaries may be displaced; inflammation can cause adhesions that obstruct the necessary path for the egg to meet the sperm.
- Eggs may lose quality; cysts on the ovaries, known as endometriomas, along with continuous inflammation, can harm the eggs and reduce female reserve.
- The pelvic region becomes an adverse environment; the body releases substances that hinder the union between the egg and sperm and prevent embryo implantation in the uterus.
- Hormonal balance is disrupted; the disease can affect hormone production, impacting both ovulation and the ability of the embryo to implant in the uterus.
It should be noted that the impact of endometriosis on fertility varies according to the severity of the disease, the location of the lesions, and other individual factors, and it is not guaranteed that every woman with the condition will face difficulties conceiving.
Can surgery help achieve pregnancy?
Tiago Castilho, an oncological surgeon specializing in gynecological surgery and deep endometriosis, states that women with endometriosis can become pregnant, although the condition complicates up to 50% of cases. He clarifies that endometriosis generates a state of chronic inflammation. Although not all ways endometriosis affects pregnancy are known, he points out that in women without documented problems, the average fertility rate is about 20% per cycle. When endometriosis is an aggravating factor, this rate can drop to between 2% and 10%.
In situations where the disease affects pelvic anatomy, such as adhesions blocking the tubes or cysts reducing ovarian reserve, surgical intervention can be part of the reversal plan. An analysis conducted by the Brazilian Society of Human Reproduction, which compiled data from eight studies, showed a pregnancy rate of 43.8% after surgery to remove endometriomas. However, the decision to operate must be made considering other elements, such as age, time of attempts, and ovarian reserve, always requiring individualized evaluation.
When there is no pain, but the disease is present
A major challenge in diagnosis is that endometriosis does not always manifest with pain. Some patients present with severe cases without feeling any perceptible symptoms.
For this reason, an accurate diagnosis requires more detailed exams, such as specialized transvaginal ultrasound and magnetic resonance imaging. These procedures can identify foci of the disease that are not visible in simple exams, following the same investigative protocol used to determine the correct path in the general diagnosis of endometriosis.
Treatment planning must be done in a personalized manner. The surgeon explains that when discussing endometriosis surgery, he asks about the patient's objective; if the focus is to get pregnant, the surgical plan will be adjusted to prioritize safety and the preservation of reproductive potential.
Investigation and specialized care
Having endometriosis does not automatically imply infertility, just as receiving a diagnosis does not mean every woman needs surgery. It is essential to individually consider the symptoms, the extent of the disease, and the reproductive goals.
If there is a desire to get pregnant now or in the future, monitoring by a human reproduction specialist is crucial throughout the management of endometriosis, even in the absence of symptoms. The surgeon and the fertility specialist can work complementarily, analyzing factors such as age, ovarian reserve, extent of the pathology, and reproductive timing to establish the most appropriate strategy for each individual.
With over ten years of experience in the treatment and surgery of women with endometriosis, Tiago Castilho also evaluates complex cases, using minimally invasive techniques, such as video surgery and robotic surgery, when surgical indication exists. The 360º Care program assists in this approach, organizing both the preparation and recovery phases.