Endometriosis

Endometriosis is a condition where tissue which normally forms in the endometrial lining, is found outside the uterus. It can be found on the ovaries, fallopian tubes, ligaments that support the uterus, or any area in within the abdominal or pelvic cavity. This misplaced tissue responds to the menstrual cycle in the same way as the normal uterine lining does. Each month the tissue builds up, breaks down, and sheds but has no way of leaving the body. The blood and tissue from the lesions begins to break down and the resulting inflammation can cause pain, scar formation, adhesions, tubal blockage, and infertility.

Among women with infertility, 25-35% are diagnosed with endometriosis. The extent of disease can range from minimal- where there are a few pelvic endometriosis implants but normal anatomical relationship of the tubes and ovaries, to severe disease which includes extensive adhesions affecting many pelvic organs. Most women (about 60%) with endometriosis have minimal to mild disease. Women with endometriosis can experience pelvic pain, infertility or both and severity of the disease does not necessarily correlate to the degree of symptoms. For instance, patients with minimal disease can have debilitating pelvic pain, while another patient with severe disease can be pain free but have infertility. Studies have confirmed that patients with even minimal to mild endometriosis have lower pregnancy rates than women without this diagnosis.

Endometriosis is diagnosed by visualization and biopsy of the lesions during laparoscopy. The surgeon can identify endometriosis by characteristic features of the lesions, which can be found anywhere within the pelvis, and remove or biopsy these lesions as well as remove any adhesions.

The cause of endometriosis is still not clear and there are many theories. The most popular theory suggests that endometrial tissue is deposited in the pelvic cavity by menstrual “back-flow” through the fallopian tubes. Some experts believe that all women experience some menstrual tissue backup and that those with endometriosis may have an immune system dysfunction or a hormonal problem allowing this tissue to grow. Other theories include lymphatic distribution of endometrial tissue to other parts of the body, genetic inheritance/predisposition, surgical transplantation and dioxin (TCCD) exposure.

Although there is no cure for endometriosis, a variety of treatment options exist. One common treatment option is achieving a pregnancy or a pseudo-pregnant state. Treatment goals include relieving/reducing pain symptoms, shrinking or slowing endometrial growths, preserving or restoring fertility, and preventing/delaying recurrence of the disease.

Treatment options are based on the symptoms that the patient is experiencing:

Infertility treatment options for patients with endometriosis will depend on many factors such as the stage of the disease (minimal vs. severe disease), the degree of scarring around pelvic organs, and ultimately the age and FSH/estradiol levels (ovarian reserve) of the patient. Fertility treatment options would include using ovulation enhancement pills, fertility hormone shots, or through IVF. If you suspect you have endometriosis or have been previously diagnosed, contact us to discuss your individual situation and fertility goals.