Endometriosis and Infertility
What is Endometriosis?
The endometrium is the inner lining of the uterine cavity. Normally, it is found only inside the uterus, but in endometriosis, this tissue is found outside the uterus in places like the outer surface of the ovary, the peritoneum (the lining of the abdomen), on the surface of the uterus, between the vagina and the rectum and between the uterus and the bladder.
Why is Endometriosis a Concern?
These endometrial deposits are also responsive to hormones and tend to bleed during every period. Bleeding triggers inflammation and pain resulting in adhesions (scar tissue). Repeated bleeding on the surface of the ovaries can predispose to chocolate cyst formation. A chocolate cyst is an endometriotic cyst that contains altered blood. Chocolate cysts can destroy normal ovarian tissue and reduce egg numbers. Chocolate cysts can also grow to very large sizes producing pain both during and in between periods. Adhesions and chocolate cysts can reduce your chance of conceiving.
What are the Symptoms of Endometriosis?
Some women with extensive endometriosis may have no symptoms at all except difficulty in conceiving. More often, women have:
- Painful periods.
- Pain during intercourse.
- Chronic pelvic pain-pain unrelated to periods.
- Bowel endometriosis can cause pain during defecation.
- Bladder endometriosis can cause painful urination and sometimes, blood in urine.
Bowel and bladder symptoms tend to occur cyclically at the time of the period.
What Causes Endometriosis?
Doctors are not entirely certain what causes endometriosis. However, there are several theories regarding the cause of endometriosis. It is also thought to have a genetic basis as it can run in families.
How is Endometriosis Diagnosed?
Endometriosis is usually diagnosed on a transvaginal scan. Laparoscopy offers a definitive diagnosis. Usually, minimal or mild endometriosis is dealt with laser ablation at the time of laparoscopic surgery. Sometimes, an MRI may be needed.
Why Does Endometriosis Cause Infertility?
Adhesions (scar tissue) can cause distortion of normal anatomy and reduce the chance of natural conception. The naturally occurring fluid within the abdominal cavity (peritoneal fluid) may contain toxins and antibodies which can reduce egg quality and cause infertility. The tubes may be damaged and blocked which impairs egg transport and fertilization.
With Endometriosis, What Treatment Will Require to Conceive?
The choice of treatment depends on the following factors:
- Duration of trying to conceive.
- The extent of the disease.
- AMH levels.
If you are younger than 30-35 years, have a good ovarian reserve and have been trying for a shorter duration of time, IUI is usually advised. If you are older than 35 years, have a poor ovarian reserve and have extensive disease, IVF may be advised. Chocolate cysts may need to be removed before IVF if the cysts are large and cause pain and if they obstruct access to egg retrieval. Treatment is usually planned on an individual basis taking various factors into consideration.