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Endometriosis and Infertility

Endometriosis is a condition affecting millions of menstruating women. Although the cause of endometriosis is unclear, treatment and management of the disease can be effective.

What is endometriosis?

The endometrium is the tissue lining the uterine interior. Endometriosis occurs when this endometrial tissue spreads outside the uterus. These small pieces of misplaced tissue – sometimes called endometrial lesions or implants – often attach to the ovaries, fallopian tubes, the uterus’ outer surface, the pelvic cavity’s lining, or other parts of the lower abdomen.

This misplaced tissue responds to a woman’s monthly cycle by building up, breaking down, and bleeding. Unlike normal uterine tissue and fluids that are expelled during menstruation, the tissue from endometriosis has no place to go. The result can be inflammation and scar tissue formation around the endometrial implants.

How endometriosis can affect infertility

About 30 to 40 percent of women with endometriosis have problems conceiving – in fact, infertility becomes more likely as the disease progresses. There are a number of ways which endometriosis can affect fertility:

  • Scarring or adhesions in the pelvis
  • The ovaries and fallopian tubes may not be in the right position, inhibiting the transfer of eggs to the fallopian tubes.
  • Damage or blockage to the inside of the fallopian tube, impeding the journey of the egg down the fallopian tube to the uterus.
  • The fallopian tubes and ovaries may adhere to the lining of the pelvis or to each other, restricting their movement.
  • Impaired implantation of an embryo in the uterus
  • Endocrine and ovulatory abnormalities, such as over-production of prostaglandins, hormones that play an important role in the fertilization and implantation of the embryo
  • Altered hormonal and cell function
  • The bodies natural inflammatory response to this “misplaced tissue” can result in the production of factors that inhibit fertility.

How do I know if I have endometriosis?

The symptoms of endometriosis can include pain, infertility, and abnormal menstrual bleeding. Pain might occur at different points in the menstrual cycle and can be severe. However, some women with even severe endometriosis may not experience discomfort.

Regardless, accurate diagnosis of endometriosis is important. Even mild cases of endometriosis can affect fertility.

Endometriosis may cause infertility due to organ damage, embryo implantation problems, increased white blood cells within the abdominal area, and stress on the immune system.

While pelvic or ultrasound exams may suggest endometriosis, the only way to definitively diagnosis the disease is with direct inspection via laparoscopy. A laparoscope is a long, thin, lighted, flexible, telescope-like instrument, inserted through a small surgical incision just below the navel. The surgeon can then view and treat, if necessary, endometriosis or other pelvic conditions. Microlaparoscopy is now available where a telescope the diameter of the tip of a ball point pen is used.

Treating endometriosis

Treatment of the disease itself may include hormone therapy, surgery, or both. For mild or moderate endometriosis pain, nonprescription pain relievers (aspirin, acetaminophen, or ibuprofen) may be helpful. If these don’t provide relief or if pain is severe, a prescription pain medication may be needed.

Some women have found additional relief using acupuncture, biofeedback, meditation, and exercise.

Hormone therapy includes the use of oral contraceptives (estrogen, progestins, or both), danazol, or GnRH agonists. These medications work by stopping ovulation temporarily. This can help the endometrial lesions shrink and stop the development of new implants.

But hormone therapy does not cure endometriosis – the disease recurs in most women when hormone therapy stops.

For some women, surgery is a good option. A surgeon can remove endometrial implants and scar tissue by cutting away, cauterizing (burning), or vaporizing with a laser. Usually a surgeon does this through laparoscopy – use of a small tube inserted into a minor incision, thus minimizing the effects of surgery.

If endometriosis is severe or if the implants cannot be reached easily with the laparoscope, more extensive surgery – laparotomy – may be beneficial. Laparotomy requires a larger incision of about four to five inches.

Hormone therapy and/or surgery to remove endometrial implants may help to relieve symptoms temporarily and may make it possible to conceive. Some women with severe endometriosis may consider hysterectomy and removal of the ovaries.

Preventing endometriosis

Researchers are working hard to determine the causes of endometriosis. For now, the most popular theory is that there may be three possible sources that make a woman more likely to have endometriosis: her genetics, immunological disorders, and Dioxin or organochlorine exposure.

In addition to regular medical care, there are two measures to take: stay informed, and, if the disease is causing problems, seek the help and support of other women going through the same experiences.