Endometriosis can Cause Infertility when Implants Occur on the Uterus, Ovaries & Tubes

Endometriosis is a condition where cells from the lining of the uterine cavity grow outside the uterus, most commonly overlying pelvic organs. The condition is associated with infertility, though it has not been proven that endometriosis causes infertility in all cases.

Approximately 15-20% of women in the general population have endometriosis. Of women with a diagnosis of infertility, 25-30% are diagnosed with endometriosis. The cause of endometriosis is unknown.

A grading system for severity of disease has been devised. Minimal disease implies a few pelvic endometriosis implants, but normal anatomic relationship of the tubes and ovaries. Severe disease can include extensive adhesions surrounding the pelvic organs. Most women with endometriosis have minimal or mild disease. The grade of disease does not correlate with the symptomatology. In other words, a patient with minimal disease can have severe pain while a patient with severe disease can be pain-free.

How is Endometriosis Diagnosed?

Endometriosis is diagnosed by performing surgery (laparoscopy). Most experienced laparoscopists would be able to identify endometriosis by characteristic features of lesions, which can be found anywhere within the pelvis. The most common sites are on the uterus, on the fallopian tubes and ovaries, and over the bladder or bowel. An experienced surgeon will do a thorough survey of the pelvis at the time of surgery to look for characteristic lesions, and may also biopsy these lesions. Diagnosis of endometriosis can be confirmed with a tissue biopsy.

How is Endometriosis Managed?

Medical treatment for endometriosis must specifically target the primary symptom, since oftentimes the treatment for one symptom may interfere with overall desired results. For instance, if the primary goal is managing pelvic pain, medical treatment can be quite effective, but it will not improve or preserve fertility. Additionally, these medications will prevent pregnancy.

Surgery can also improve pain symptoms, especially if the patient has advanced disease. If the primary symptom is infertility, medical suppression would not play a role. Surgical management may improve fertility for patients with moderate-to-severe disease who have anatomical distortion of the pelvic organs due to adhesions, scarring, or large endometriosis cysts of the ovaries. For patients with minimal-to-mild disease, it is unclear whether surgery will improve fertility chances. Most studies confirm that patients with minimal or mild endometriosis have much lower pregnancy rates than women without this diagnosis.

Did You Know?

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