Endometriosis

Endometriosis occurs when the same tissue found in the uterine lining attaches to pelvic organs and begins to grow. The condition is common and occurs in an estimated 10 percent of women of reproductive age, but 40-50% of infertile women.

Endometriosis can develop in the lining of the pelvis and abdomen, ovaries and fallopian tubes. It can even spread to the outer surfaces of the uterus, bladder, ureters, intestines, rectum and the cul-de-sac space behind the uterus.

Since endometriosis implants react to estrogen, during the menstrual cycle, the implants located outside the uterus grow and bleed just like the uterine lining. This causes swelling and inflammation in surrounding tissue and adhesions – scar tissue – can eventually develop.

There are four stages of endometriosis. The location, extent, depth of the endometriosis implants, as well as the presence and severity of adhesions determine the stage. The likelihood of infertility is high in stage III-IV.

Symptoms of Endometriosis

Not every woman who has endometriosis has symptoms. When symptoms are present, they may include some or all of the following:

• Severe menstrual cramps
• Chronic pelvic pain
• Painful intercourse
• Heavy menstrual periods
• Infertility

Painful bowel movements and urination can occur if the bowel or bladder is affected by endometriosis.

Endometriosis and Infertility

Endometriosis is found in up to half of all infertile women. Reduced fertility occurs when inflammation from endometriosis damages the sperm or egg or hinders movement through the fallopian tubes and uterus. Adhesions can block the release of eggs, prevent sperm from entering the fallopian tubes and hinder the fallopian tubes from picking up eggs during ovulation.

Diagnosing Endometriosis

If fertility is an issue and endometriosis is suspected, your reproductive endocrinologist may investigate  the diagnosis through a pelvic exam, ultrasound, CT scan, or MRI.  While these tests may be highly suggestive, no imaging study can establish the diagnosis of endometriosis.  Only direct visualization at surgery (whether laparoscopy or open surgery) can confirm the diagnosis of endometriosis.

These tests enable your fertility specialist to determine whether or not endometriosis is present and evaluate the extent of the condition. During laparoscopy, dye may be injected into the fallopian tubes to test for obstruction. Scar tissue may also be removed and endometriosis removed or destroyed.

Treatment of Infertility Caused by Endometriosis

Depending on the severity of endometriosis, surgical removal of endometriosis implants or adhesions may be performed on women who wish to preserve their fertility. Surgery improves pain in up to 80 percent of patients. One large-scale study found that 29 percent of women who underwent surgery for the treatment of endometriosis became pregnant within nine months.

Medical treatments such as birth control pills, progestins, GnRH analogs and danazol have not been found to improve fertility, although these medications may reduce pain caused by endometriosis. Hormonal therapy may also slow endometrial tissue growth and prevent the formation of new adhesions.

Women aged 35 and older who have been diagnosed with endometriosis may benefit from fertility-enhancing treatments such as controlled ovarian stimulation, intrauterine insemination and assisted reproductive technology.