Newswise — New research published today (Wednesday) in Human Reproduction [1], one of the world's top reproductive medicine journals, establishes a connection between endometriosis and decreased fertility during the period preceding a conclusive surgical diagnosis of the condition.
In the initial investigation examining birth rates among a significant cohort of women who later underwent surgical confirmation of endometriosis, Finnish researchers discovered that the quantity of initial live births prior to diagnosis was halved compared to women unaffected by this distressing condition. Remarkably, this trend persisted across various forms of endometriosis, including ovarian, peritoneal, deep endometriosis, and other types.
Furthermore, the researchers uncovered compelling evidence indicating a substantial decrease in the number of offspring women had prior to the diagnosis of endometriosis, in stark contrast to women without the condition.
Professor Oskari Heikinheimo, head of the study from Helsinki University Hospital (Finland), conveyed, "Based on our findings, it is crucial for healthcare professionals attending to women experiencing distressing menstrual pain and chronic pelvic discomfort to consider the potential presence of endometriosis and administer appropriate treatment promptly. In addition to addressing age-related fertility concerns, doctors should engage in discussions with these women regarding the potential impact of endometriosis on their fertility. The aim should be to minimize any fertility impairment by promptly providing relevant treatment for endometriosis."
Endometriosis, an enduring inflammatory ailment, afflicts approximately 10% of women within their child-bearing years. It involves the abnormal growth of uterine lining tissue in locations beyond the womb, such as the fallopian tubes and ovaries. Common symptoms encompass agonizing menstrual periods, pelvic pain, discomfort or pain during sexual intercourse, and difficulties in conceiving. Unfortunately, the accurate diagnosis of endometriosis is often significantly delayed, with an average delay of approximately seven years. While surgery has traditionally served as the "gold standard" for diagnosing the condition and determining the type of endometriosis, alternative methods such as ultrasonographic findings or symptom assessment alone are currently accepted means of diagnosis.
To date, limited data has been available regarding the live birth rate among women affected by endometriosis, and there remains a dearth of knowledge concerning the potential impact of various types of endometriosis on fertility, particularly in the period preceding a formal diagnosis.
Professor Heikinheimo emphasized the significance of their study, stating, "Considering the chronic nature of endometriosis and the considerable delay in its diagnosis, we aimed to investigate potential disparities in the rates of initial live births prior to diagnosis within a substantial population of women."
Professor Heikinheimo and his team conducted an extensive examination involving 18,324 women in Finland, ranging in age from 15 to 49 years, who underwent surgical confirmation of endometriosis between 1998 and 2012. These women were matched with 35,793 individuals of similar age who did not receive an endometriosis diagnosis. The follow-up period commenced at the age of 15 and extended until the occurrence of the first live birth, sterilization, removal of the ovaries or uterus, or until the surgical diagnosis of endometriosis, depending on which event transpired first. Furthermore, the group of women with endometriosis was subdivided into four categories based on the specific type of endometriosis they exhibited.
The average (mean) time of follow-up before surgical diagnosis was 15.2 years. The average (median) age at the time of diagnosis of endometriosis was 35 years.
During the follow-up period, a total of 7,363 women (40%) diagnosed with endometriosis and 23,718 women (66%) without endometriosis successfully delivered a live-born baby. Notably, the incidence rate of first live births among women with endometriosis was half that of women unaffected by the condition, standing at 0.51%. Further analysis based on the women's birth decades spanning from the 1940s to the 1970s revealed a declining trend in birth rates for both groups. Significantly, over the course of the decades, a progressively lower rate of first live births was observed among women with endometriosis compared to those without the condition. In women born between 1940 and 1949, the difference in live birth rates between the two groups prior to surgical diagnosis of endometriosis was 28%. However, this disparity steadily increased to 87% in women born between 1970 and 1979.
Professor Heikinheimo proposed a plausible explanation for the observed patterns, stating, "We hypothesize that this trend is linked to women having their first child at an older age, earlier surgical diagnosis of endometriosis, and the cumulative detrimental effects of endometriosis on affected women."
The study revealed that the average number of children women had before being diagnosed with endometriosis was 1.93, while women unaffected by endometriosis had an average of 2.16 children.
Professor Heikinheimo emphasized the significance of early diagnosis and treatment of endometriosis, stating, "The potential impact of endometriosis on a woman's desired number of children underscores the importance of timely identification and treatment of this condition."
Continuing his remarks, Professor Heikinheimo added, "It is crucial to recognize that this study focuses on live births that occurred prior to a confirmed diagnosis of endometriosis. In our forthcoming research, we will delve into the fertility rates following surgical diagnosis and treatment of endometriosis. Our aspiration is that the fertility outcomes for women with endometriosis will align with those of women unaffected by the condition after undergoing surgical management."
The study's notable strengths lie in its extensive sample size and the utilization of high-quality national health care registers, providing comprehensive information on women throughout Finland. However, there are several limitations to consider. Firstly, the study exclusively focused on surgically-confirmed cases of endometriosis, potentially excluding women with milder symptoms who received treatment for the condition. Additionally, there was a lack of available data regarding the desire for pregnancy among the participants. The study did not account for the potential influence of fertility treatments or the impact of adenomyosis, a condition often associated with endometriosis that can also affect fertility and pregnancy outcomes. Lastly, differences in socioeconomic and educational backgrounds between the two groups of women may have influenced the findings.
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