Endometriosis can make conception difficult, but not impossible

Endometriosis is a progressive disease. It occurs when blood during menstruation flows backwards into the pelvic area where endometrium cells attach to neighbouring organs, forming cysts and lesions. Among other symptoms, endometriosis is a leading cause of infertility. Up to 40% of women seeking fertility treatments are diagnosed to have endometriosis.

Obstetrician and gynaecologist A/Prof Fong Yoke Fai (Photo by Shah Rizal Baharudin)

The question is why? According to Associate Professor Fong Yoke Fai, from the Astra Laparoscopic and Robotic Centre For Women and Fertility, more women with endometriosis are experiencing difficulty conceiving because they are opting to have babies later in life and often amid late-stage disease.

“Two or three generations ago, women not only conceived earlier but had more babies and were breastfeeding, two factors that put menstruation on hold temporarily,” says A/Prof Fong.

“When menstruation stops, there is no back flow of menstrual blood to cause endometriosis, increasing your chances of conception. If women with endometriosis put off having babies until their thirties, they may have 15 to 20 years of interrupted menstrual cycle which increases their risk of late-stage endometriosis and a greater likelihood for infertility,” adds A/Prof Fong.

One of A/Prof Fong’s patients, Constance Seah, an early childhood educator shares with us how she gave birth to not one, but three babies through endometriosis.

Constance Seah, endometriosis patient who conceived (Photo is her own)

What were your first experiences of endometriosis?

Constance Seah Su Ann (early childhood educator, 34): My first symptoms began at 11. As early as two weeks before my menses, I developed symptoms such as menstrual cramps, cold sweats, and irritable bowel syndrome (IBS) symptoms such as constipation and diarrhoea.

Once my menstruation began however, the flow was so heavy, I often stained my school uniform and bed sheets despite using heavy-duty sanitary products. In my late teens, the symptoms had affected my social life and ability to perform academically. When I consulted GPs about my condition, they simply brushed off my complaints as normal symptoms of menstruation.

My bleeding was also irregular, sometimes menstruating twice a month or not at all for two or three months.

How did you conceive through endometriosis? Did it cause any complications during your pregnancies?

At 22, I got married. After three years in 2012, I gave birth to my eldest son without complications. At the time, I had not yet been diagnosed with endometriosis and therefore had no clue I was living with and conceiving through the condition.

Three years later in 2015, I had my second child, a daughter.  Although I did not experience complications during my second pregnancy, I experienced abnormal post-partum bleeding and fainting spells two months after giving birth.

This was when I was referred to A/Prof Fong who recommended a pelvic ultrasound scan, which showed up endometriosis lesions along my uterus and ovaries. I was diagnosed with Stage 2 endometriosis. This was the first time I had ever heard of the condition and did not understand what it was.

I decided against treatments for my endometriosis as I was still breastfeeding and planned on having another child. I got pregnant with my third child, a son, in September 2016. Unlike my previous two pregnancies, the third one was difficult. I experienced intense cramps during the first few weeks of gestation.

To guard against miscarriage brought about by endometriosis’ potential to affect hormone levels, I was ordered to undergo hormone injections and hormone pills twice a week throughout my first and second trimester.

As my pregnancy was considered high-risk, I delivered my third child via C-section. He has also been diagnosed with global developmental delay, which was likely caused by complications during pregnancy.

Did you conceive your children naturally?

All my children were conceived naturally. Back-to-back pregnancies and breastfeeding at a young age improved my chances of conception and prevented my condition from advancing further before. It was finally resolved with laparoscopic surgery in June 2018. I much prefer being with child as not only does pregnancy eliminated all endometriosis symptoms, but labour pains paled in comparison to menstrual cramps.

What advice do you have for other women with endometriosis who want to get pregnant?

I also advise women with endometriosis to persevere and never give up hope. If getting pregnant naturally is difficult, take heart there are fertility treatments that can improve your chances of conception. I also advise young women to be proactive about their reproductive health. If you have abnormal symptoms, such as painful menstrual cramps, irregular or heavy menstrual bleeding, speak to a gynaecologist early because prompt diagnosis is the best way to prevent disease progression and improve quality of life.