Endometriosis

Endometriosis 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.

The 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.

The 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.

Endometrial 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 laparoscopy.

Laparoscopic 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.

The 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.