Endometriosis is a common gynaecological condition that affects approximately 1 in 10 women and can sometimes be overlooked or take time to diagnose. It occurs when tissue similar to the lining of the uterus grows outside the uterine cavity, commonly in areas such as the ovaries, fallopian tubes, bowel, and bladder. Endometriosis can cause pelvic pain, painful periods, and other symptoms, and may also affect fertility. Understanding the condition, its symptoms, and available management and treatment options can help women make informed decisions about their reproductive health.

Endometriosis can cause a range of symptoms, and their severity can vary from one person to another. Some people may have mild symptoms or no noticeable symptoms at all. Common symptoms may include:

• Pelvic pain: Painful periods, chronic pelvic pain, or pain that may worsen during menstruation
• Pain during sexual intercourse: Deep pelvic pain during or after sex
• Painful bowel movements: Discomfort or pain when passing stool, particularly during menstruation
• Gastrointestinal symptoms: Bloating, constipation, diarrhoea, or abdominal discomfort
• Painful urination: Discomfort when urinating, particularly during menstruation
• Heavy or painful periods: Menstrual bleeding that is unusually heavy or accompanied by significant pain
• Fatigue and lower back pain: Ongoing fatigue or lower back and pelvic discomfort
• Difficulty conceiving: Endometriosis may affect fertility and can make it more difficult to become pregnant

Identifying symptoms is an important first step when endometriosis is suspected. An ultrasound may provide further information by assessing the pelvic organs and looking for signs such as an endometrioma, a type of ovarian cyst associated with endometriosis, as well as other visible abnormalities or adhesions. However, ultrasound cannot always detect endometriosis, and a normal ultrasound does not necessarily rule out the condition. A healthcare professional may recommend additional assessment based on your symptoms and individual circumstances.

Laparoscopy may be used to assess and diagnose endometriosis when appropriate. The procedure is performed under general anaesthesia through small incisions in the abdomen, allowing a camera and surgical instruments to examine the pelvic organs directly. If endometriosis is identified, surgical treatment may sometimes be performed during the same procedure to remove or treat visible endometriosis and adhesions. This may help relieve symptoms and, in some cases, support fertility depending on the individual’s circumstances.

Despite a diagnosis of endometriosis, many individuals can still conceive naturally. However, endometriosis can be associated with infertility and may affect fertility through several mechanisms. For example, endometriosis and associated adhesions can alter the anatomy of the ovaries and fallopian tubes, which may interfere with the normal movement of eggs and sperm. In addition, inflammation associated with endometriosis may affect the pelvic environment and may influence ovulation, egg quality, fertilisation, and embryo implantation. The impact of endometriosis on fertility varies from person to person and may depend on the severity and location of the condition.

If endometriosis is suspected or you have concerns about how it may affect your fertility, speaking with a fertility specialist can help you understand your condition and available options. An individualised assessment can help guide decisions about fertility management and treatment, particularly if you are planning to conceive or have experienced difficulty becoming pregnant.

While endometriosis can affect fertility, a diagnosis does not mean that pregnancy is impossible. Treatment and fertility management options may include:

• Laparoscopic Surgery: Surgery may be considered to remove or treat visible endometriosis and adhesions, depending on the severity and location of the condition.
• Hormonal Treatment: Hormonal medications may be used to manage endometriosis symptoms and suppress the activity of endometriosis. These treatments generally prevent ovulation and are therefore not used to achieve pregnancy while undergoing treatment.
• Fertility Treatment: If endometriosis is affecting the ability to conceive, assisted reproductive treatments such as IVF or ICSI may be considered based on individual circumstances, fertility factors, and treatment goals.

Get all your questions answered and receive guidance on your next steps from our Fertility team.

Endometriosis can be associated with infertility and may affect fertility through changes to the pelvic anatomy, including the ovaries and fallopian tubes, as well as inflammation associated with the condition. These factors may interfere with the normal processes involved in ovulation, fertilisation, and embryo implantation. The impact of endometriosis on fertility varies depending on its severity, location, and other individual fertility factors.

At Genea Thailand, our fertility specialists provide personalised assessment and discuss appropriate fertility management and treatment options. For individuals experiencing difficulty conceiving due to endometriosis or other fertility factors, assisted reproductive treatments such as IVF and ICSI may be considered based on individual circumstances and treatment goals.