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 may be considered as part of a fertility treatment plan for individuals 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 may affect fertility in some individuals.

Here's how endometriosis may affect fertility:

• 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, which may affect the normal function of the reproductive organs.

• Egg quality:

  • Endometriosis may also negatively impact egg quality, which may affect fertility.

• Hormonal disruption:

  • Endometriosis may affect hormonal balance in several ways, including disrupting ovulation, shortening the luteal phase and reducing the receptivity of the womb lining to a fertilised egg. Together, these changes can affect fertility.

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 changes that may affect normal reproductive function, 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, which may affect the normal function of the uterus.

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, the impact on fertility varies depending on the severity of the condition and individual circumstances. 

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 may be considered as a fertility treatment option for some individuals 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. In some cases, IUI may be combined with a technique called superovulation (SO-IUI), which uses fertility medication to stimulate the development of more than one egg during a treatment cycle.

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 stimulate the development of multiple follicles before IUI. 

Fertility drugs, usually administered through injections, are used to conduct controlled ovarian hyperstimulation to produce more than one mature egg. This encourages the development of more than one mature follicle.

SO-IUI combines fertility medication to stimulate the development of multiple eggs with IUI, where prepared sperm is placed directly into the uterus during ovulation. This approach may be considered in selected cases, such as unexplained infertility, mild male factor infertility or mild endometriosis, depending on the individual’s fertility profile and your doctor’s assessment.

What are the success rates of IUI for endometriosis?

Treatment outcomes for IUI in women with endometriosis can vary depending on the stage of endometriosis and other individual fertility factors. Published figures from some studies have reported:

• Stage 1-2 (Mild): Pregnancy rates of around 5–10% per treatment cycle

• Stage 3-4 (Moderate–Severe):Pregnancy rates of below 5% per treatment cycle in some patient groups

Some studies also suggest that pregnancy rates may be higher in women under 35 years old, although age is only one of several factors that may influence treatment outcomes. Your fertility specialist will consider this alongside your overall fertility profile when discussing the most suitable treatment approach.

How to support your fertility if you have endometriosis

If you have endometriosis and are trying to conceive, your fertility specialist may recommend a combination of lifestyle measures, fertility treatment options such as IUI or in vitro fertilisation (IVF), or, in some cases, surgery as part of your care plan.

You can also take steps to support your reproductive health and overall well-being, such as:

• 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 BMI supports your overall health

• Get regular exercise:

  • A regular exercise plan with moderate intensity, such as brisk walking and swimming, can supports your overall wellbeing

• Sleep:

  • Getting adequate sleep for at least 7 to 9 hours supports your overall health

• Avoid smoking:

  • Avoiding smoking supports your overall reproductive health.

Your fertility specialist may also discuss other approaches based on your individual circumstances, such as:

• 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?

Published figures from some studies have reported pregnancy rates of around 5–10% per treatment cycle in women with mild endometriosis. Lower pregnancy rates have been reported in some women with moderate to severe endometriosis, although treatment outcomes can vary depending on individual fertility factors and the severity of the condition.

Can endometriosis interfere with implantation?

Endometriosis may affect implantation by causing changes in the uterine environment and inflammation, particularly in more advanced stages of the condition.

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?

Age can influence fertility in women with endometriosis, and fertility specialists may encourage earlier assessment if you are planning to conceive, as fertility and egg quality can decline with age.

Is 35 too old for IUI?

Not necessarily. IUI may still be considered after the age of 35, depending on your individual circumstances. Published figures from some studies have reported pregnancy rates of around 15–20% per treatment cycle in women under 35, and around 10–15% per treatment cycle in women aged 35 and above, although outcomes can vary from person to person.

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.