IUI and Endometriosis: Can Intrauterine Insemination Help You Conceive?

Fertility journeys can be full of uncertainty, especially after an endometriosis diagnosis . You might be wondering how these abnormal growths affect your chances of conception and whether fertility treatments like intrauterine insemination (IUI) can help.

Here's what you should know about IUI and how it can help increase your chances of conceiving with endometriosis.

What is endometriosis?

Endometriosis is a condition where tissue similar to the lining of your womb (endometrium) grows outside of its normal location. The endometrial-like tissue can grow in various locations throughout your pelvis, most commonly on your ovaries, fallopian tubes, and the tissue lining your pelvis.

In rare cases, it may also be found in more distant locations such as the intestines, bladder, or even the lungs. When it grows in the area it's not supposed to be, it can cause inflammation and scarring to the surrounding tissue.

This condition usually affects women between 25 and 40 years old. However, endometriosis can also affect younger women during their teenage years.

Symptoms of endometriosis

Common symptoms of endometriosis include:

• Painful periods: 

  • Pelvic pain and cramping may start before a menstrual period and last for days into it. You also may have lower back and stomach pain. Another name for painful periods is dysmenorrhea.

• Pain during sex: 

  • Pain during or after sex is common with endometriosis.

• Pain with bowel movements or urination:

  • You're most likely to have these symptoms before or during a menstrual period.

• Excessive bleeding:

  • Sometimes, you may have heavy menstrual periods or bleeding between periods.

• Unexplained infertility:

  • For some people, endometriosis is first found during tests for infertility treatment.

• Other symptoms: 

  • You may have fatigue, diarrhoea, constipation, bloating, or nausea. These symptoms are more common before or during menstrual periods.

However, there will be some people with endometriosis who do not experience symptoms. But for women who do experience it, endometriosis can sometimes appear to be another condition that causes pelvic pain.

These include pelvic inflammatory disease and ovarian cysts. It may also be misinterpreted as irritable bowel syndrome (IBS), which can occur alongside endometriosis.

If you are experiencing unexplained infertility coupled with symptoms of endometriosis, please visit a fertility specialist. For further assessment and tailored treatment options, request an appointment with a fertility specialist at Thomson Medical.

How does endometriosis affect fertility?

If you experience endometriosis and are trying to conceive, it’s possible to become pregnant and give birth to a healthy baby. However, endometriosis often grows on or around the reproductive organs, which can make conception more difficult.

Here's how these abnormal growths might affect your chances of conceiving:

• Reduced ovarian reserve: 

  • When endometrial tissue forms on your ovaries (called endometriomas), it may damage them and reduce the number of available eggs in them (ovarian reserve).

• Tubal blockage: 

  • If endometrial-like tissue grows around your fallopian tubes, it can cause blockages that prevent sperm from reaching the egg and fertilising it.

• Pelvic inflammation: 

  • This condition can cause chronic inflammation that affect reproductive organs, making the environment less conducive to implantation.

• Egg quality: 

  • Endometriosis may also negatively impact egg quality, reducing the chances of successful fertilisation and healthy embryo development.

• Hormonal disruption: 

  • Since endometriosis interferes with ovulation, disrupts the time between ovulation and the next period (luteal phase), and makes the womb lining less receptive to a fertilised egg, this abnormal growth can lead to hormonal disruption within the body.

How does endometriosis affect ovulation, fallopian tubes, and the uterus?

Endometriosis can significantly impact ovulation, fallopian tubes, and the uterus, often leading to fertility challenges. It can cause damage to the ovarian reserve, blockages in the fallopian tubes, and a hostile environment for egg fertilisation and implantation within the uterus, largely due to inflammation and scarring. 

How endometriosis affects each area:

• Ovaries:

  • Endometriosis can affect egg development, causing fewer eggs and impacting egg quality. The inflammation and scarring can also affect follicle development and ovulation.

• Fallopian tubes:

  • Endometrial tissue growth around the fallopian tubes can cause blockages, preventing sperm from reaching the eggs and hindering fertilisation. 

  • Scar tissue can also distort the tubes and prevent proper egg transport.

• Uterus:

  • Endometriosis can create a hostile environment for implantation due to inflammation and altered immune responses. 

  • Scar tissue and adhesions from endometriosis can also distort the uterine lining, impacting embryo implantation.

Stages of endometriosis

Based on the severity and location of the tissue growth, endometriosis can be classified into four stages:

• Stage I (minimal):

  • During this early stage, there are small patches of endometrial tissue that grow outside of the womb with little to no scarring around the growth.

• Stage II (mild): 

  • If the condition progresses, there are more areas that are affected by the endometriosis growth. However, these implants are relatively small with no scarring or tissue damage.

• Stage III (moderate): 

  • During this stage, multiple deep implants of abnormal tissue are present, along with the formation of small cysts on one or both ovaries. 

  • Adhesions (scar tissue that causes organs to stick together) or ovarian endometriomas may also be present around the fallopian tubes or ovaries.

• Stage IV (severe): 

  • At this most severe stage, there is extensive abnormal growth throughout the pelvic area, large ovarian endometriomas, and significant scarring or adhesions that may cause organs to stick together.

Can I naturally conceive with endometriosis?

Yes, it is possible to conceive naturally with endometriosis, but it can sometimes be more challenging. While endometriosis can impact fertility, many individuals with the condition are still able to conceive without intervention. The severity and location of endometriosis can affect the chances of natural conception, with mild to moderate cases often having a higher likelihood of success. 

Is IUI suitable for endometriosis?

Intrauterine insemination (IUI), or artificial insemination, involves placing a specially washed and concentrated semen sample directly into your uterus during ovulation. IUI can help increase conception chances with endometriosis. 

This fertility treatment is often recommended when endometriosis is present but fallopian tubes remain open, or when the growth is mild to moderate. To help increase your chances of conceiving, IUI can be combined with a technique called superovulation (SO-IUI), which stimulates the release of multiple eggs each month.

What is SO-IUI?

Superovulation with intrauterine insemination (SO-IUI) is a form of assisted reproductive technology that combines superovulation (using fertility drugs to stimulate the ovaries to produce multiple eggs) with IUI (placing prepared sperm directly into the uterus) to increase the chances of conception. 

Fertility drugs, usually administered through injections, are used to conduct controlled ovarian hyperstimulation to produce more than one mature egg. This increases the number of eggs available for fertilisation.

By combining SO and IUI, SO-IUI aims to increase the chances of fertilisation by increasing the number of eggs available and placing the sperm closer to the egg. This combined approach is particularly beneficial for couples facing unexplained infertility, mild male factor infertility, or women with mild endometriosis.

What are the success rates of IUI for endometriosis?

The success rates of IUI for women with endometriosis will depend on the stage of endometriosis.

• Stage 1-2 (Mild): IUI offers a modest successful pregnancy rate of 5-10% per cycle.

• Stage 3-4 (Moderate–Severe): Success rates drop below 5% per cycle, and IVF may be preferred.

It is important to know that the successful pregnancy rates for women with endometriosis undergoing IUI are highest in those under 35 years old.

How to increase your chance of conceiving with endometriosis

To improve your chances of conceiving with endometriosis, it's recommended that you adopt a healthy lifestyle, consider fertility treatments like IUI or in vitro fertilisation (IVF), and explore surgical options for removing endometriosis tissue.

Otherwise, you can make the following lifestyle changes to increase your chance of conceiving with endometriosis:

• Having a balanced diet: 

  • Consume a diet rich in protein, antioxidants, omega-3 fatty acids, and vitamins, and cut down on inflammatory foods, including caffeine, sugar, meat, and alcohol.

• Staying hydrated: 

  • Consume at least 2 to 3 litres of water daily 

• Maintaining a healthy weight:

  • Maintaining a healthy body mass index (BMI) is important to improve fertility 

• Get regular exercise:

  • A regular exercise plan with moderate intensity, such as brisk walking and swimming, can help to improve IUI success rate 

• Sleep: 

  • Getting adequate sleep for at least 7 to 9 hours is important for conception

• Avoid smoking:

  • Smoking reduces the IUI success rate 

Other ways you can improve your chances of a successful pregnancy are by:

• Trying to conceive earlier (ideally before age 35)

• Managing your endometriosis symptoms

• Taking medications recommended by your fertility specialist.

FAQ

How successful is IUI for endometriosis?

Success rates for IUI in women with mild endometriosis are roughly 5-10% per cycle. Rates decrease for moderate to severe disease.

Can endometriosis interfere with implantation?

Yes, endometrial changes and inflammation can reduce the likelihood of an embryo successfully implanting in the uterus, particularly in more advanced stages.

Can IUI cause pelvic inflammatory disease?

The risk of pelvic inflammatory disease (PID) after IUI is very low, approximately 0.16 in 1,000 cycles. It does increase slightly after repeated procedures but remains rare. No routine antibiotic is required unless a specific risk is identified.

What age is best to get pregnant with endometriosis?

Experts recommend trying to conceive before age 35, as fertility naturally starts to decline and egg quality decreases after that point.

Is 35 too old for IUI?

While IUI can still be attempted after age 35, the success rate declines to around 10-15% per cycle. Under 35, rates are closer to 15–20% per cycle.

Is gender selection possible in IUI?

IUI does not allow for reliable gender selection; such options are only available with advanced techniques like IVF paired with preimplantation genetic testing.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice based on your unique situations, please consult a specialist at Thomson Medical. Request an appointment with Thomson Medical today.