ENDOMETRIOSIS AND FERTILITY
The endometrium is the tissue that lines the inside of the uterine cavity. Endometriosis is a disease state in which some of this tissue has spread elsewhere – such as to the ovaries, or elsewhere in the abdominal cavity. Endometriosis causes pain in some women and can also cause infertility. 5-10% of all women have endometriosis. Most of these women are not infertile. 30-40% of infertile women have endometriosis.
Diagnosis of endometriosis
The only way to be sure whether a woman has endometriosis is to perform a surgical procedure called laparoscopy that allows us look inside the abdominal cavity with a narrow scope. Sometimes we strongly suspect that the disease is present based on the woman’s history of very painful menstrual cycles, painful intercourse, etc., or based on the physical examination of the woman or ultrasound findings.
The large majority of cases of endometriosis are mild.
Women with any stage of endometriosis (mild, moderate, or severe) can have severe lower abdominal and pelvic pain – or they might have no pain or symptoms whatsoever. Although mild endometriosis is associated with infertility in some women, many fertile women also have mild endometriosis.
Severe endometriosis causes pelvic scarring and distortion of pelvic anatomy. The tubes can become damaged or blocked and the ovaries often contain cysts of endometriosis (endometriomas) and may become adherent to the uterus, bowel or pelvic side wall, frozen pelvis. Any of these anatomic distortions can result in infertility. In some cases the eggs in the ovaries can be damaged, resulting and reduced egg quantity and quality.
Treatment for endometriosis
The choice of treatment for infertility in endometriosis is to get fertility treatment and result as early as possible. If the endometriosis is grade IV, (Frozen pelvis), the best treatment choice will be surrogacy.