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Endometriosis is a common cause
of infertility (up to
40%) and pelvic pain in women.  Endometriosis appears to be
more common in daughters of women who had endometriosis
suggesting a genetic link. It produces symptoms
such as pain during menstruation, intercourse, bowel
movements, or emptying the bladder. It is also often present
with no symptoms.
Endometriosis is caused when the
cells that normally line the uterine cavity (the endometrium)
enter the pelvic cavity and attach to various organs.
It is commonly seen on the rectum, ovary,
uterus, and tubes, during the laparoscopy. Endometrial lesions
present in many forms including the classical dark blue, dark brown, or black lesions. It may also present in a "non classical" lesion that may be white, red. or yellow.
Endometriosis occurs when endometrial cells
enter the pelvic cavity through a back flow of blood
during the menstrual cycle and attach to internal organs. Menstrual blood is rich
in endometrial cells since it results from a breakdown
of the endometrium. Once in the bloodstream, endometrial
cells can travel throughout the body. This explains
why endometrial lesions been documented in many organs
distant to the pelvic cavity, including the lungs and the brain.
Endometriosis is typically "staged" according to its severity and likelihood of causing infertility. The stages include minimal-stage 1, mild-stage 2, moderate-stage 3, and severe-stage 4.
Endometriosis- Effects on Fertility
Endometriosis can affect
fertility in many different ways:
- Failed or irregular ovulation
- Causing inflammatory processes within the pelvic cavity
- Failed or impaired fertilization
- Chronic pelvic inflammation leading to inhibition of embryonic development
- It can cause physical damage to important reproductive organs such as the fallopian tubes.
Endometriosis is supported by the hormones estrogen and progesterone which stimulates rapid endometrial
cell growth. These hormones also stimulate the lining of the uterus (endometrium) which must thicken
and become more vascular to provide support and nourishment for a developing
embryo. As estrogen levels rise, development of
the endometrium follows. Unfortunately, it also stimulates endometrial cell growth on other body structures.
Endometriosis is dependent
on estrogen for growth so drug treatments aim at reducing
estrogen levels.
It is commonly treated with Lupron, a gonadotropin releasing hormone (GnRH) agonist. It competes
with GnRH causing a drop in the production of FSH and
LH by the pituitary leading to lowered estrogen levels. Once the estrogen levels decline the patient can experience all of the side effects normally associated with the menopause. However, endometrial cell growth will be slowed.
Endometriosis
is often surgically removed during the laparoscopy.
Fertility specialists meticulouslyremove all endometriosis lesions
as there is some evidence that even small amounts of
endometriosis can lower pregnancy rates. A reproductive
endocrinologist should perform the laparoscopy for the evaluation of infertility. These highly trained specialists
can often treat the disease
during the diagnostic laparoscopy. When a fertility specialist is chosen, it is usually not necessary to repeat the diagnostic laparoscopy for treatment thus reducing patient inconvenience, cost, and potential surgical side effects.
If endometriosis has penetrated the fallopian tubes, IVF may be the best treatment option. Tubal damage may be so severe that surgical treatment may not be a viable option. There may also be severe damage to the ovaries or other internal organs.
Endometriosis and Infertility an article by Susan Sarajari's, MD, PhD, FACOG
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