Endometriosis often reduces the woman’s ability to get pregnant. Around 30-50% of women with endometriosis have infertility. Dr. Alejandra García-Villalba, shares her expertise about endometriosis alongside the management and care that is provided by Vida Fertility

Endometriosis is a complex and often misunderstood condition that affects approximately 10% of women of reproductive age worldwide. For many, it is a silent struggle, with symptoms often dismissed as “normal” period pain. However, when endometriosis interferes with fertility, it becomes an even greater challenge.

To shed light on this condition and its impact on conception, we spoke with Dr. Alejandra García-Villalba, gynaecologist and fertility specialist, and Medical Director at Vida Fertility Alicante, who explains the importance of early diagnosis and personalised care in successfully managing endometriosis and achieving pregnancy.

What is Endometriosis?

Endometriosis occurs when tissue similar to the uterine lining (endometrium) grows outside the uterus, commonly affecting the ovaries, fallopian tubes, and pelvic lining. This misplaced tissue behaves like normal endometrial tissue—thickening, breaking down, and bleeding during each menstrual cycle but with no way to exit the body, causing inflammation, scarring, and adhesions.

Symptoms of Endometriosis

While some women experience no symptoms, others suffer from:

• Severe menstrual pain (dysmenorrhea)
• Pain during intercourse (dyspareunia)
• Chronic pelvic pain
• Heavy or irregular periods
• Digestive issues (bloating, diarrhoea, constipation)
• Fatigue
• Difficulties conceiving

According to Dr. García-Villalba, “The severity of symptoms does not always correlate with the extent of the disease. Some women with mild endometriosis have intense pain, while others with extensive endometriosis may not experience any discomfort.”

Diagnosis of Endometriosis: The Key to Treatment

Diagnosing endometriosis has traditionally been delayed for years, as symptoms are often mistaken for common menstrual issues. However, advancements in diagnostic methods are improving detection rates.

Methods of Diagnosing Endometriosis

• Pelvic Exam: A doctor may feel abnormalities, such as cysts or scar tissue.
• Ultrasound: Helps detect endometriomas (ovarian cysts) but may not identify smaller endometrial implants.
• MRI Scans: Useful for assessing deep infiltrating endometriosis.
• Laparoscopy: A minimally invasive surgery where a camera is inserted to examine and, if necessary, remove endometriotic lesions.

• Endotest® – A Saliva-Based Diagnosis:

In recent developments, France has begun covering a saliva test called Endotest, which identifies endometriosis with high accuracy using genetic markers. “Non-invasive testing methods like Endotest are a major step forward in diagnosing endometriosis earlier, potentially reducing the time to treatment,” notes Dr. García-Villalba.

How Endometriosis Affects Fertility

Endometriosis is a leading cause of infertility, with 30-50% of women with the condition experiencing difficulties conceiving. The disease affects fertility in several ways:

• Inflammation and Scarring: Endometriotic lesions and scar tissue can distort reproductive organs, making natural conception difficult.
• Blocked Fallopian Tubes: Adhesions can prevent the egg from meeting the sperm.
• Poor Egg Quality: Chronic inflammation can reduce ovarian reserve and affect the quality of oocytes.
• Hormonal Imbalances: Endometriosis can disrupt ovulation, making it harder to conceive naturally.

According to Dr. García-Villalba, “Many women with endometriosis still manage to conceive, but some may require assisted reproductive techniques (ART) to achieve pregnancy.”

Fertility Treatments for Women with Endometriosis

There is no one-size-fits-all solution for endometriosis-related infertility. Treatments depend on age, disease severity, and reproductive goals. Options include:

1. Ovulation Induction and Timed Intercourse: For mild cases, hormonal stimulation may help release a mature egg at the right time for
   conception.
2. Intrauterine Insemination (IUI): If fallopian tubes are open and there is minimal endometriosis, IUI can improve the chances of
   fertilisation.
3. In Vitro Fertilisation (IVF): IVF is often the best option for moderate to severe endometriosis, as it bypasses many of the disease’s barriers to conception. “IVF allows us to retrieve eggs directly from the ovaries, fertilise them in the lab, and transfer the healthiest embryo back into the uterus,” explains Dr. García-Villalba.
4. Surgery to Remove Endometriotic Lesions: In cases where endometriosis is severe, surgery may be necessary to improve fertility outcomes before attempting IVF.
5. Egg Freezing for Future Fertility: Since endometriosis progressively reduces ovarian reserve, egg freezing can be a proactive option for women who want to preserve their fertility.

The Importance of Early Diagnosis and Personalised Care

Diagnosing endometriosis as early as possible is crucial in preventing complications and preserving fertility. “At Vida Fertility, we take a comprehensive, patient-centred approach, offering tailored fertility treatments and ongoing support for women struggling with endometriosis,” says Dr. García-Villalba.

Struggling with Endometriosis and Fertility? Let Us Help

If you suspect you have endometriosis or have been struggling to conceive, our team at Vida Fertility Madrid and Alicante is here to provide expert guidance. Contact us today for a personalised fertility consultation and explore your options for starting a family. Request more information here.

Learn more about Vida Fertility here.

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