Endometriosis – A Primary Cause of Female Infertility

Endometriosis, one of the common organic causes of female infertility, is a condition in which endometrial tissue, the tissue that lines the inside of the uterus, grows outside the uterus and gets attached to other organs in the abdominal cavity such as the fallopian tubes and ovaries. Symptoms of endometriosis include abnormal menstrual bleeding, severe pain during menstrual periods, painful urination, and pain during or after sexual intercourse. Endometriosis is a progressive disease that tends to get worse over time.

Prevalence of Endometriosis

Endometriosis is estimated to affect over one million women (estimates range from 3% to 18% of women) in the United States. It is one of the leading causes of pelvic pain and reasons for laparoscopic surgery and hysterectomy in the country. The condition is more prevalent in white women as compared with African American and Asian women.

Endometriosis affects women in their reproductive years with most cases diagnosed in women aged around 25-35 years. It has also been reported in girls as young as 11 years of age. Endometriosis is rare in postmenopausal women. Again, many women may have the condition but without any symptoms.

Diagnosis of Endometriosis

After a medical history and pelvic exam is completed, a laparoscopy is necessary to confirm a diagnosis of endometriosis. The physician then classifies the endometriosis condition as stage 1 (minimal), stage 2 (mild), stage 3 (moderate) or stage 4 (extensive) based on the amount of scarring and diseased tissue found. The best line of treatment is then worked out based on the stage of endometriosis, and may include medication or surgery, or a combination of both.

How Does Endometriosis impact fertility?

The reasons for a decrease in fertility among women with endometriosis might be due to both anatomic and hormonal factors. The presence of endometriosis may involve masses of tissue or scarring (adhesions) within the pelvis that may distort the Fallopian tubes. The scarring and adhesions that takes place may mean that the ovaries and fallopian tubes are not in the right position, so the transfer of the egg to the fallopian tubes cannot take place. Again it also affects the safe passage of the egg down the fallopian tube to the uterus.

Endometriosis is an autoimmune disease and can be associated with other autoimmune issues that can lead to implantation failure and pregnancy loss.

Endometriosis may affect fertility because of the over-production of prostaglandins which are hormones that play an important role in the fertilization of the egg and implantation of the embryo.

Endometriosis may also result in the formation of ovarian cysts called endometrioma that may also interfere with ovulation.

Since painful intercourse is often an outcome of endometriosis, it reduces the chances of conception.

Treatment Options for endometriosis induced infertility

Many women with endometriosis have children without difficulty. Others become pregnant eventually with the help of a combination of medical therapy, surgery, and assisted reproduction techniques.

Surgical treatment

Surgery for endometriosis-related infertility aims to get rid of any endometriosis and adhesions present. If the endometriosis has damaged any organs, or resulted in them being stuck down in abnormal positions, the surgery will also try to repair the damage and restore the anatomy of the organs to as close as possible to their normal positioning.

In women with minimal to mild endometriosis, laparoscopic surgery is an effective treatment for endometriosis-related infertility, as it leads to better pregnancy rates.

A Positive Note

Most women with endometriosis will still be able to conceive, especially those with minimal to mild endometriosis. However women with moderate to severe endometriosis tend to have more difficulty conceiving.

However, the heartening news is that having endometriosis does not automatically mean that you will never have children. Rather, it means that you may face problems in the journey towards parenthood.

At East Bay Fertility Center California (www.ebfertlity.com), we recommend In-vitro fertilization (IVF) as the therapy of choice for severe cases of endometriosis. Endometriosis and pelvic adhesions are sometimes also treated by laparoscopy.
Our experienced medical staff is headed by Dr. Ellen U. Snowden, Medical Director and physician. Dr Snowden is Board Certified in Obstetric, Gynecology, and Reproductive Endocrinology, with advanced Fellowship training in the treatment of infertility, recurrent miscarriages and hormonal disorders in women. Dr. Snowden brings to her patients a rare and valuable firsthand empathy for the personal pain and emotional stress of dealing with infertility.