Endometrioma and Fertility: Can It Affect Your Chances of Pregnancy?

If you or someone close to you has been diagnosed with an endometrioma (ovarian endometriotic cyst), it is natural to worry about what it could mean for your fertility. Many women affected by the condition often wonder how the cyst could potentially affect their chances of having a baby. The simple answer is that fertility depends on the size, location, and severity of the endometrioma. The best way to combat the condition is to have sufficient awareness to make informed decisions with your doctor. Let’s dive deeper.

Table of Contents

• What is An Endometrial Cyst?
• Endometrial Cyst Symptoms
• How are Endometrioma and Fertility Connected?
• How Is Endometrioma Diagnosed?
• Available Treatment Options for Ovarian Endometrial Cyst
• When Should You See A Doctor?
• Conclusion
• Frequently Asked Questions (FAQs)

What is An Endometrioma?

Endometriosis is a condition where tissue resembling the inside of a woman’s uterus develops outside the uterus. If this tissue develops into a blood-filled cyst in the ovary, it is called an endometrioma, also referred to as an ovarian endometriotic cyst. They are filled with old blood that is thick and dark and are therefore often called “chocolate cysts”. Endometriomas are among the most common forms of endometriosis and may affect pelvic anatomy, ovarian function, and fertility. In women, they may lead to chronic pelvic pain, which makes it painful for them to engage in several daily tasks. Early detection and medical treatment are key in managing the effects of endometriosis, preserving fertility and improving the quality of life.

Endometrioma symptoms

The first step in evaluating an endometrioma or suspected endometriosis is a thorough medical history, where the doctor reviews symptoms that may suggest the presence of the disease. During the consultation, the doctor may ask about:

• Menstrual cycle and the severity of period pain
• Pain during ovulation
• Changes in bowel habits during periods
• Pain while passing urine
• Pain during bowel movements
• Pain during sexual intercourse
• Digestive symptoms related to eating or food habits
• Difficulty conceiving
• Previous surgeries or treatments for endometriosis

Anyone experiencing these symptoms should see a gynaecologist for a proper examination and early diagnosis.

How are Endometrioma and Fertility Connected?

The big question is, ‘How does an Endometrioma cause infertility?’ Endometrioma and fertility are connected in a handful of ways, even if the relationship is complicated. According to multiple studies, an ovarian endometrial cyst can affect your chances of pregnancy through:

• A Reduced Ovarian Reserve: Women are born with a finite number of eggs, known as their ovarian reserve. In the case of an endometrioma, the resulting inflammation can damage healthy ovarian tissue around it, eventually decreasing the number and quality of the available eggs.

• Distorting the Pelvic Anatomy: Endometrioma is usually associated with endometriosis-related scarring, or ‘adhesions’. Such adhesions in the pelvis can lead to distortion of the position of the ovaries, fallopian tubes and uterus. This makes it harder for the egg to travel from the ovary to the fallopian tube.

• Causes Inflammation: The fluid inside the Endometrioma is loaded with inflammatory substances and iron from the breakdown of old blood. This leads to oxidative stress in the ovarian tissue surrounding the cyst, which can affect egg quality as they mature.

• Surgery: Removal of the Endometrioma by surgery is needed if the cyst becomes very large. If there is a possibility of developing cancer, a cystectomy may be recommended. During surgery, some healthy ovarian tissue may be removed with the cyst wall, and this may lead to a reduced ovarian reserve.

How is Endometriosis Evaluated?

To evaluate suspected endometriosis, several types of clinical evaluations as well as investigations are performed.

• Detailed medical and menstrual history
• Clinical pelvic examination
• 2D or 3D pelvic ultrasound
• MRI with contrast, especially for deep infiltrating endometriosis
• Blood tests, including tumour markers such as CA-125 and CA 19-9, in selected cases

These investigations can help confirm the stage of endometriosis and assist doctors in formulating the best treatment plan. However, laparoscopy remains the gold standard for confirming endometriosis in selected cases, particularly when imaging findings are inconclusive or when surgical intervention is being planned.

Available Treatment Options for Endometrioma (ovarian endometriotic cyst)

While there is no definite cure for an Endometrioma, it can be treated/managed in a lot of ways, including medications and surgical options.

• Medications: Medications that help regulate hormonal fluctuations may be prescribed to manage symptoms. These include birth control pills, vaginal rings, and patches.
• Surgery: Surgery may be recommended when symptoms are severe, fertility is affected, medical treatment does not provide adequate relief, or the endometrioma is large or has concerning imaging features. The primary goals of surgery are to:

1. Restore normal pelvic anatomy
2. Relieve chronic pelvic pain
3. Improve fertility outcomes

Whenever possible, surgery is performed using minimally invasive techniques, such as laparoscopic or robotic-assisted surgery, which generally support faster recovery. However, in selected complex cases, an open abdominal procedure may be necessary to ensure safe and effective treatment.

• Monitoring: When the cyst is small and does not necessarily cause symptoms, your healthcare provider may recommend watchful monitoring of its growth.
• Fertility Treatment: Those women with a reduced ovarian reserve or a distorted anatomy can opt for fertility treatments such as IVF (In Vitro Fertilisation).

When Should You See A Doctor?

Issues related to fertility and your overall reproductive health should be brought to the attention of a doctor the moment you sense something is wrong. Visit a gynaecologist if you have:

• Persistent pelvic pain
• Difficulty conceiving despite trying for 6-12 months
• A history of endometriosis in your family

Conclusion

Endometrioma and fertility are linked to each other in several ways, but you need to know that having an endometrial cyst does not always mean the end of your dream of getting pregnant. Many women with an Endometrioma can still get pregnant either naturally or through assisted reproductive techniques such as IVF. The bottom line is that while such cysts can influence fertility, they do not determine the outcome. You can successfully get pregnant if you receive the right diagnosis at the right time, a personalised treatment plan, and subject yourself to regular monitoring.

Frequently Asked Questions (FAQs)

1. Can I get pregnant naturally if I have an endometrioma?

   Many women can still get pregnant naturally if they have a small endometrioma. Your chances are especially higher if you have a normal ovarian reserve and tube function.

2. Can an endometrioma come back after treatment?

   Yes, it is possible for an endometrioma to come back after treatment. Recurrence is usually associated with the size of the original cyst, your age, and the treatment you have had.

3. Are endometrial cysts different from regular ovarian cysts?

   While normal ovarian cysts may resolve on their own, endometrial cysts are filled with old blood and do not resolve on their own.

4. Can medication shrink an endometrioma?

   Hormonal medications can help slow growth and control symptoms, but cannot eliminate the cyst entirely by themselves.

5. Is it recommended to have surgery before I try to get pregnant?

   Your doctor will recommend the best approach based on the size of the endometrioma, your symptoms, ovarian reserve, and fertility goals.

If you have a small cyst, doctors often recommend IVF as an alternative because surgery has a good chance of reducing your ovarian reserve.