Endometriosis, a common cause of female infertility, causes the tissue that normally lines the inside of the uterus to spread to the outside. The invading tissue from the endometrium may also attach itself and grow on organs or structures within the woman’s pelvis – including the ovaries.
This disease is usually not dangerous, but sometimes causes abdominal discomfort or severe pain. It spreads progressively and should be treated as soon as possible.
Endometriosis is found in 35 percent of women with no other diagnosed infertility problem, according to the American Society for Reproductive Medicine (ASRM). Experts do not know why some women develop endometriosis, and it is not completely understood why it is harder for women with endometriosis to conceive. However, many women with endometriosis do become pregnant after medical treatment.
Prevalence of endometriosis in the general population is unknown because many women can have the disease without experiencing symptoms. Studies estimate that approximately 5 percent of all women undergoing surgery for any gynecologic condition have endometriosis. In women undergoing surgery for pelvic pain, 12 to 32 percent have lesions, and in women having surgery for infertility, 21 to 48 percent have endometriosis.
Many women with endometriosis have no symptoms, but those who do commonly experience pelvic pain, which becomes more severe during menstrual periods. Endometriosis is also characterized by abnormal menstrual bleeding and pain during or after sexual intercourse.
Infertility is considered a potential symptom of endometriosis, and in some cases the disease is not discovered until a woman is examined and tested for infertility. While having endometriosis does not mean that a woman will always have difficulty conceiving and having children, it may be harder to become pregnant.
To confirm an endometriosis diagnosis, a woman will first have a medical history review and pelvic exam, and then undergoes a laparoscopy – a simple outpatient surgery. At the time of laparoscopy, the surgeon will usually be able to resect or destroy the endometriosis using laparoscopic scissors, cautery (electrical energy that burns the lesions) or a laser. Even if the endometriosis does not cause scarring that blocks the fallopian tubes, removing the endometriosis seems to improve pregnancy rates, possibly by improving the pelvic environment so that eggs are not harmed by the toxic effects of the lesions.
A non-surgical approach may also be used to treat endometriosis. By suppressing hormone levels (especially estrogen) using birth control pills or other agents, endometriosis lesions lose their hormonal support and subsequently wither away. There is a tendency for the lesions to come back, however, after the suppression is stopped.
For women who wish to conceive, surgical treatment is preferred since it does not delay attempts at getting pregnant as with hormonal suppression. The diagnosing doctor will be able to give advice on the best treatment option, taking into account the woman’s level of endometriosis.
In chronic or severe cases, a woman with endometriosis who wants her own biological children may consider assisted reproductive technologies such as in vitro fertilization (IVF).