子宫内膜异位症及其对生育能力的影响

主要收获

• “Silent endo” means you can have endometriosis and fertility problems even if you don’t feel pelvic pain.
• Endometriosis doesn’t only block tubes; it can cause inflammation that may harm egg quality.
• Removing the disease by cutting it out (excision) is usually more effective for protecting fertility than burning it (ablation), which may leave some behind.
• If you already know you have endometriosis or have strong symptoms, don’t wait a full year. See a specialist after about 6 months of trying to conceive.
• The best results often come from both medical treatment (especially surgery when needed) and lifestyle changes that reduce inflammation.

子宫内膜异位症 is a chronic condition where tissue similar to the uterine lining grows outside the uterus, causing intense inflammation, scarring, and adhesions. It impacts fertility by distorting pelvic anatomy and creating a hostile chemical environment that affects egg quality and embryo implantation, making it significantly harder to conceive without targeted medical intervention.

In Malaysia, many women are told to simply endure period pain and stay quiet about it, often just using a hot water bottle to cope. But when that pain is followed by years of trying and struggling to get pregnant, it can lead to worry and emotional stress.

We will go deeper into endometriosis and how it may affect fertility, and help you understand what steps you can take to move forward toward motherhood. 

How Endometriosis Affects Your Fertility

Endometriosis is not just extra tissue. It is a long-term inflammatory disease that can affect fertility in different ways. There are two main ways it makes conception difficult: physical blockage and biological disruption.

Scar Tissue and Blocked Movement

Endometriosis can cause adhesions, which are bands of scar tissue inside the pelvis.

These adhesions can:

• Make the ovaries stick to nearby organs or the pelvic wall
• Pull or distort the fallopian tubes
• Stop the tubes from moving freely to pick up the egg during ovulation

Normally, the fimbriae (finger-like ends of the fallopian tubes) catch the egg after ovulation. If they cannot reach the egg, fertilisation cannot happen.

Inflammation Around the Reproductive System

Endometriosis also creates a strong inflammatory environment in the pelvis.

Lesions release chemicals such as prostaglandins and cytokines, which increase inflammation. This can be thought of as an unhealthy fluid environment around the reproductive organs.

This inflammation may:

• Damage the DNA quality of eggs
• Reduce sperm movement and survival
• Make the uterine lining less receptive for embryo implantation

So even if fertilisation happens, implantation may still fail.

The Silent Endo Problem

A key challenge with endometriosis is that pain does not always match severity.

This means:

• Some women with advanced (Stage IV) endometriosis may feel little or no pain
• Others with mild (Stage I) endometriosis may experience severe pain

Many women only discover silent endometriosis when they investigate unexplained infertility.

If:

• Your hormone tests are normal
• Your partner’s sperm analysis is normal
• But pregnancy is still not happening

Then endometriosis may be a hidden cause worth checking.

Endometriosis Treatment: The Key Difference Between Excision and Ablation

When treating endometriosis, especially if you want to protect your ovarian reserve (your egg supply), the type of surgery matters a lot.

1. Ablation Surgery

Ablation uses heat or laser to burn away visible endometriosis on the surface.

However:

• It often does not remove the full disease
• It is like cutting the top of a weed while the roots stay underground
• The heat may also accidentally damage nearby healthy ovarian tissue

Because of this, it may not fully solve the problem long term.

2. Excision Surgery

Excision surgery is considered the ideal treatment for endometriosis.

In this method:

• The surgeon carefully cuts out the entire endometriosis tissue, including the roots
• This helps reduce the chance of the disease coming back
• It is more precise and focused on full removal

For women with an endometrioma (a cyst on the ovary):

• Special excision techniques are used
• The goal is to remove the cyst wall
• While keeping as many healthy eggs as possible

Choosing the right surgical approach can make a big difference in:

• Fertility outcomes
• Egg preservation
• Long-term symptom control

Endometriosis Diagnosis & Fertility: Tests and How Doctors Support Egg Quality

Endometriosis can affect fertility, so doctors use different tests and strategies to understand your condition and protect your egg quality. The most accurate way to confirm endometriosis is through surgery, but other tools help guide treatment.

1. Laparoscopy and Imaging

Traditionally, a laparoscopy (a small surgical procedure using a camera) was the only way to confirm endometriosis. While it remains the preferred choice for a definitive diagnosis, modern technology has changed. 

Today, specialized doctors can often detect deep endometriosis and ovarian cysts using advanced ultrasound or MRI before you ever enter an operating room.

It is:

• The only way to officially diagnose endometriosis
• Used to directly see and confirm endometriosis tissue

2. AMH Blood Test

The AMH (Anti-Müllerian Hormone) test measures how many eggs you likely have left (your ovarian reserve).

This is important because:

• Endometriosis may reduce egg quantity and quality
• Poor or repeated surgery can also affect egg count
• AMH helps doctors plan the right treatment approach

3. Advanced Ultrasound Scans

Specialized pelvic ultrasound scans can help detect signs of endometriosis, such as:

• “Kissing ovaries” (when ovaries stick together)
• Deep endometriosis nodules

These may not always show up in a standard ultrasound.

4. Supporting Egg Quality While Waiting for Treatment

While preparing for treatment, you can support your body by reducing inflammation and oxidative stress.

Helpful steps include:

• Eating an anti-inflammatory diet (more Omega-3 foods, fewer processed sugars)
• Taking supportive supplements like CoQ10 (may help protect egg quality)

These steps do not cure endometriosis, but they may help improve overall reproductive health while you wait for treatment.

了解更多： 什么是子宫内膜异位症：马来西亚居民综合指南

Choosing the Right Specialist for Fertility Treatment

In Malaysia, many women first see a general Obstetrician/Gynecologist for period pain. 

This is a good starting point, but when endometriosis affects fertility, you may need a more specialized doctor.

When to See a Specialist

If you are dealing with:

• 怀孕困难
• Suspected or confirmed endometriosis
• Complex pelvic pain

You should consider seeing a Fellowship-trained Minimally Invasive Gynecologic Surgeon (MIGS).

Why MIGS Specialists Matter

A MIGS specialist is trained in advanced keyhole (laparoscopic) surgery.

They are important because they:

• Perform complex endometriosis excision surgery
• Use precise techniques to remove disease safely
• Focus on protecting your reproductive organs and ovarian reserve

This level of expertise is especially important for fertility preservation.

Questions You Should Ask Your Doctor

It is important to be informed and confident when discussing treatment options. You can ask:

• “Do you perform excision or ablation surgery?”
• “How will you protect my ovarian reserve during the procedure?”

For fertility-related endometriosis, choosing the right specialist can make a big difference in treatment outcomes and your chances of conception.

结论

Endometriosis can be difficult to deal with, but it does not mean you won’t be able to conceive.

Instead of just accepting pain or waiting, it is important to take a more active approach to your health. This means seeking proper medical advice and making informed decisions about your care.

Getting pregnant with endometriosis often depends on seeing a specialist who can safely remove the condition while protecting your fertility and egg supply. The right care should also balance effective treatment with long-term reproductive health.

在 柔佛鹰格医院, Tey Shea Reen 博士 offers minimally invasive keyhole surgery and patient-focused care. This support can help women with severe period pain, unexplained infertility, or those seeking safe, fertility-preserving treatment move forward toward building a family.

医疗免责声明： This content is for informational purposes only and does not substitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or a qualified health provider regarding a medical condition. 

资料来源 

• ESHRE (European Society of Human Reproduction and Embryology): 2022 Guidelines on Endometriosis. (Primary source for diagnosis and management).
• The Lancet: Endometriosis: a review of clinical diagnosis, treatment, and pathogenesis (2021/2022).
• Journal of Clinical Medicine: The Impact of Endometriosis on Pregnancy Outcomes (2023).
• Royal College of Obstetricians and Gynaecologists (RCOG): Green-top Guideline No. 24.