Endometriosis and Infertility
What is Endometriosis?
Endometriosis is the appearance of tissue similar to the tissue that lines the uterus (endometrium) in other parts of the body. Endometrial growths, also called implants, can develop on the ovaries or fallopian tubes, the outer surface of the uterus, the bowels, or other abdominal organs. In rare cases, they may even adhere to organs outside of the abdominal cavity. During a woman’s menstrual cycle, her uterine lining (endometrium) first grows, and then if there is no fertilized egg during that cycle breaks down and is expelled from the body as menstrual blood. For a woman with endometriosis, the implants that are located outside of the uterus go through that same growing, breaking down, and bleeding process. Sometimes the growth of these implants causes pelvic pain, pain during intercourse or pain during urination or bowel movements. Birth control medication is often used as a therapy to relieve the pain of endometriosis because the hormones in the birth control pills shrink the endometrial growths.
What’s the Infertility Link?
While a diagnosis of endometriosis doesn’t mean that you are infertile, up to 40% of women with endometriosis do have problems getting pregnant. The reason endometriosis interferes with fertility is not fully understood, but there are several hypotheses. One is that the adhesions of endometrium on other reproductive organs interfere either with proper ovulation or with the necessary movement of a fertilized egg from the fallopian tubes into the uterus. Women with endometriosis also over-produce prostaglandins, and some have theorized that this leads to a hormonal imbalance that interferes with fertilization and implantation of an embryo.
Why endometrium sometimes shows up elsewhere in a woman’s body remains a bit of a medical mystery, but it does look like there is a genetic link. If you are having trouble getting pregnant and one of your female relatives has been diagnosed with endometriosis, let your doctor know so that he or she can determine whether you might also have the disease. Sometimes endometriosis is first uncovered as part of the diagnostic process for a woman with fertility problems when laparoscopy, a surgical procedure that gives the physician a magnified view of the abdominal cavity, reveals endometrium growths in other parts of the abdomen.
What about Treatment?
Of course the standard treatment for endometriosis of birth control hormones is not the strategy a woman wants to use if she is trying to get pregnant. Sometimes a physician can remove adhesions of endometrial tissue surgically (sometimes even during the same laparoscopic procedure that diagnosed the endometriosis). If removing adhesions is not by itself enough to permit a woman to become pregnant, many of the advanced reproductive technologies available can be the solution for a woman with endometriosis.
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