Jeffrey B. Russell, MD Board Certified Reproductive Endocrinologist, Infertility Specialist Yale University Trained
Endometriosis is a disorder of the female reproductive system in which endometrial tissue (the normal lining of the uterus) is found outside the uterine cavity. An estimated three to five million American women of reproductive age suffer from endometriosis. This disease is prevalent in women 30-40 years of age, though it can begin in the late teens and early twenties. About 40% of patients with endometriosis will experience some degree of infertility.
The relationship between endometriosis and infertility is not completely understood. The primary cause of infertility resulting from endometriosis appears to be a blockage caused by scarring and adhesions in the tubes. These adhesions can prevent the egg and sperm from meeting or prevent the fertilized egg from moving down the tube normally (resulting in an ectopic pregnancy).
The other connection between endometriosis and infertility is the generalized effect or irritation of the endometrial tissue causing the fimbriae ( fallopian tube fingers which pick up the egg) not to perform properly in allowing the egg and the sperm to meet.
Women with endometriosis often, but not always, have one or more of the following symptoms: dysmenorrhea (painful cramps during menstruation); dyspareunia (painful intercourse); dysfunctional or irregular uterine bleeding, including heavy periods or unusual spotting during their cycle. In about 30% of women, there are no symptoms except infertility.
Diagnosis of endometriosis is made by a combination of tests, including: a careful history of the symptoms and menstrual cycle, a thorough pelvic examination including an ultrasound to look at the ovaries for the possibility of severe endometriosis, and a laparoscopy, which allows the physician to look inside the pelvic and abdominal cavity to view the ovaries, fallopian tubes and other internal structures.
For a woman who wishes to attempt pregnancy, treatment will have two goals: unblocking tubes and removing any adhesions that may affect conception, allowing fertilization and movement of fertilized eggs down the fallopian tubes to the uterus and reducing the inflammation or irritation surrounding the fallopian tubes by suppressing ovulation which stimulates the disease . Lupron is a medication that was originally used for treating endometriosis to suppress the disease process. Laser surgery is another option which directly removes the endometrial lesions. The direct treatment for moderate to severe endometriosis is to bypass the disease process by doing IVF.