is one of the most common causes of infertility, being
a component in over 40% of cases. Endometriosis occurs
when the tissue that normally lines the uterus travels
to other internal structures, attaches, and grows.
embryo implants in the endometrial lining of the uterus;
therefore it must thicken and become more vascular to
provide nourishment. Endometrial cells have the ability
to divide rapidly and are stimulated by the hormones
estrogen and progesterone. The endometrial cells retain
this proliferation characteristic when they attach to
other structures. These "endometriomas" can
attach to, constrict, and/or penetrate internal structures,
including the reproductive organs.
most common theory explaining how endometrial cells
enter other parts of the body is that there is a "back
flow" of menstrual blood into the abdominal cavity
during menses. Endometrial cells can also enter the
bloodstream and implants have been reported on most
organs including the lungs, intestines, tubes, ovaries,
uterus, etc. There also seems to be a genetic component.
Female children of women with endometriosis have a greater
chance of having the disease.
cells require the hormone estrogen for support and growth.
Lupron is commonly used to treat endometriosis because
it blocks the production of estrogen, thus starving
the endometrial cells. Unfortunately, Lupron also temporarily
causes menopausal side effects. The degree of endometriosis
is described as stages one through four (from minimal
to severe). It can be very painful especially during
menses, intercourse, and bowel movements. Endometriosis
can be suspected by pelvic or abdominal ultrasound,
physical examination, and the diagnosis confirmed by
can also attach to the fallopian tubes and cause
disease is usually diagnosed by the HSG. It
is sometimes treated during the diagnostic laparoscopy.
Read the "Tubal
Disease" section for more information.
surgery is often required to remove endometrial implants.
Many times endometriosis is treated during the routine
diagnostic laparoscopy. This is the reason a skilled
reproductive surgeon should perform the laparoscopy
for infertility diagnosis and treatment. Some data suggests
that very small amounts of endometriosis can create
an inflammatory environment leading to lower success
rates when employing assisted reproductive technology.
Therefore, it is extremely important that all endometrial
implants be removed.
prognosis for pregnancy outcome depends upon the degree
and location of the endometriosis. Many times medication
and/or surgery is effective in controlling endometriosis
and restoring fertility.