Dr Lisa Hansard - How does Endometriosis cause infertility?
Causes of Infertility: Endometriosis Causes, Symptoms, & Treatment
Endometriosis is a common condition affecting women
who are in their reproductive years. It occurs when
the lining of the uterus (the endometrium) develops
and grows in abnormal locations (e.g. on the ovaries
or the lining of the pelvic cavity). When these
cells are found in abnormal locations, endometriosis
can lead to problems specifically including pelvic
pain and infertility. Endometriosis is thought to
develop when cells that shed during a menstrual
period flow backward into the pelvic cavity rather
than forward into the vagina – a process known as
“retrograde menstruation”. Although retrograde
menstruation is very common, occurring in up to 95%
of women of reproductive age, it is not clear why
some women are more susceptible to developing
endometriosis than others.
The Symptoms of Endometriosis
It is estimated that up to 10% of all women of reproductive age have
endometriosis, compared to 25-50% of women with infertility.
Classic symptoms of endometriosis include severe menstrual cramps (“dysmenorrhea”),
painful intercourse (“dyspareunia”), and chronic pelvic pain.
Endometriosis is thought to be the cause of 20% of cases of chronic
pelvic pain, however many women with endometriosis may have
relatively mild or even no symptoms whatsoever. In our practice,
infertility is the only symptom that many women have.
Symptoms alone cannot reliably be used to make a definitive
diagnosis of endometriosis. Your physician may suspect that you
have endometriosis based on certain physical exam or ultrasound
findings. A family history of endometriosis, infertility, and/or
chronic pelvic pain may further increase suspicion.
Using Laparoscopy to Diagnose Endometriosis
Often, the
only way to diagnose endometriosis with certainty is laparoscopy. This is an outpatient surgical procedure that enables your doctor to
evaluate your pelvic organs by using an operative telescope and
other surgical instruments that are passed into your abdomen through
1-3 small incisions. General anesthesia is required for this
procedure, which typically takes 1-2 hours to perform. If
endometriosis is found, it can be treated during the same procedure
– typically by vaporizing it with a laser. The goals of laparoscopy
are to remove or destroy as much endometriosis as possible, while
restoring the normal arrangement of the pelvic organs. This can
help to minimize pelvic pain as well as to improve fertility.
Endometriosis can have a variety of appearances when viewed through
a laparoscope. Endometrial implants can appear in small patches
that can be clear, white, red, brown, or blue. They can also create
filmy or dense scar tissue which can cause pelvic organs to stick
together. A cyst of endometriosis – sometimes called an
endometrioma or “chocolate cyst” is a more severe form of
endometriosis which can sometimes be found in one or both ovaries.
Endometriosis is classified as stage I (mild)-IV (severe) depending
on the extent and location of the implants, as well as the presence
and extent of scar tissue and/or endometriomas. Though most women
have stage I (minimal) or II (mild) endometriosis, they can still
have significant pelvic pain and/or infertility, as the extent of
endometriosis does not always correlate well with the amount of
symptoms.
Endometriosis & Fertility Treatment Options
The fertility treatment options that will be available to you
following surgery depend on both your laparoscopic findings as well
as your other fertility factors. If your doctor finds minimal,
mild, or even moderate endometriosis, and everything else in your
evaluation is normal (sperm count, ovulation, etc.), he or she may
offer you a variety of treatment options ranging from trying on your
own to more advanced therapies.
If, on the other hand, you have severe endometriosis or even
significant pelvic scarring in the absence of extensive
endometriosis, your best option may be to proceed rapidly to in
vitro fertilization (IVF). The most severe cases of endometriosis
are usually the most resistant to surgical treatment. In these
cases, IVF typically represents the best chance for pregnancy – and
pregnancy is the best treatment to prevent the rapid recurrence of
severe endometriosis. Regardless, laparoscopy affords your physician
the opportunity to thoroughly evaluate and correct any pelvic
abnormalities, and then recommend the best treatment option for your
particular condition(s).
Though endometriosis can be a frustrating and painful condition,
with a significant adverse effect on fertility, effective treatment
options are available. Your physician can help you decide the next
best step if you have been diagnosed with or are concerned about
endometriosis.
