Delayed endometriosis diagnosis reduces chance of pregnancy by 33%

In Australia, it currently takes an average of 6.5 years from symptom onset for the one in nine Australian women with endometriosis to eventually receive a diagnosis.
 
And for those undiagnosed women, almost half (40%) will experience difficulty falling pregnant without fertility treatments such as in vitro fertilisation (IVF), according to newly published research from the University of Queensland.
 
However, the study also suggests prompt diagnosis can help, as those patients who were diagnosed with endometriosis before fertility treatment experienced the same pregnancy outcomes as those without the condition.
 
‘Early diagnosis of endometriosis and early access to IVF created a level playing field, as the same outcomes were recorded for women who did not have the condition,’ study author Professor Hayden Homer said.
 
‘It is highly advantageous to diagnose endometriosis before starting fertility treatment and to adjust the treatment accordingly. 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.’
 
While the detection and diagnosis of endometriosis can be a timely and complex process given the varied symptoms, GPs are well placed to help – should they recognise the signs.
 
Women’s health GP Professor Danielle Mazza recently told newsGP that the delay can often be attributed to symptoms being addressed without a diagnosis.
 
‘Often GPs may be offering management, like girls commencing on contraception for difficulties with their periods more broadly, and many of the contraceptive products that we utilise can also be utilised as a treatment for endometriosis,’ she said.
 
‘So it may be that symptoms subside or are treated without a diagnosis ever necessarily having been made.
 
‘[But] when they come off those hormonal products and want to become pregnant … their endometriosis may recur, or there may be scarring from previous endometriosis.’
 
Professor Mazza said recently developed clinical practice guidelines on endometriosis are designed to address these issues, and were partly informed by endometriosis consumer groups identifying ‘an unacceptable delay from women seeking care for their symptoms to diagnosis and management being put in place’.
 
The University of Queensland study used national self-reported data collected between 1996 and 2018 from 1322 participants in the Australian Longitudinal Study on Women’s Health, as well as linked data on endometriosis, fertility treatments and births.
 
‘Thirty-five per cent of participants had endometriosis and one-third of those weren’t diagnosed until after they started their fertility treatment,’ study lead Dr Katrina Moss said.
 
‘Women who were diagnosed late were four times more likely to do a lot of cycles, sometimes up to 36 cycles of fertility treatment … [and] were also 33% less likely to report a birth.’
 
According to Dr Moss, Australian women can wait 4–11 years before being diagnosed with endometriosis.
 
Other research findings include that one in three (34.7%) women using fertility treatment had endometriosis, with 65.6% of these diagnosed before the first round of treatment, and 34.4% after.
 
Those diagnosed after the first round of treatment were more likely to use intrauterine insemination (IUI), do more (11–36) cycles, and less likely to report a birth, compared to women without endometriosis – despite no marked difference in age of starting treatment.
 
Also noted is the possibility that some of the study participants in the ‘no endometriosis’ group did actually have endometriosis and were unaware of it.
 
The authors concluded that their findings add fresh insight that there is only a difference in fertility treatment outcomes for women with endometriosis if they are diagnosed prior to commencing the therapy, with a delayed diagnosis presenting disadvantage during the treatment.
 
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