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Undiagnosed endometriosis compromises fertility treatment

Undiagnosed endometriosis can drastically affect a woman’s ability to fall pregnant as well as the success of any fertility treatment undertaken, according to a new study from the University of Queensland, published today in the journal Human Reproduction.

This is particularly alarming because around one in nine Australian women is affected by the condition, and diagnosis can take years.

UQ School of Public Health researcher Dr Katrina Moss says women whose endometriosis went undiagnosed until after they began fertility treatment ended up doing more cycles, used treatments that aren’t recommended, and were less likely to have a baby.

“By contrast, our study found women who were diagnosed with endometriosis before fertility treatment experienced the same outcomes as those without the condition,” Moss says.

Endometriosis is an often-painful condition that causes endometrial tissue – the tissue that usually lines the inside of the uterus – to grow outside the uterus, often in the fallopian tubes, ovaries or pelvic lining. Even though these tissues are not inside the uterus, they respond to changes in the hormone cycle, thickening and then bleeding with a woman’s period: this can lead to inflammation and scarring.

More reading: An AI that can diagnose endometriosis?

Endometriosis is chronically under-diagnosed, in part because it can be mistaken for the painful symptoms of ordinary PMS, but it’s also often mistaken for irritable bowel syndrome (IBS) and other conditions.

“In our national study of 1322 women, 35% of participants had endometriosis and one-third of those weren’t diagnosed until after they started their fertility treatment,” Moss said.

“Women who were diagnosed late were four times more likely to do a lot of cycles, sometime up to 36 cycles of fertility treatment,” she said.

“They were also 33% less likely to report a birth.”

Fertility specialist and UQ Centre for Clinical Research professor Hayden Hommer says early diagnosis of endometriosis and early access to IVF creates a level playing field, with the same outcomes recorded for women who did not have the condition.

“It is highly advantageous to diagnose endometriosis before starting fertility treatment and to adjust the treatment accordingly,” he says. “Otherwise, women are less likely to have a child and face a higher financial and psychological treatment burden.

“It is critical to remain highly vigilant about the possibility of endometriosis amongst women who are thinking about fertility treatment, especially in the presence of severe pelvic pain.”

The study compiled data from the Australian Longitudinal Study on Women’s Health (ALSWH), a population-based study examining the health of around 40,000 Australian women over a 20-year period.