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At least 10% of women of reproductive age in the US have endometriosis. Among women suffering from infertility, that number is estimated to be 40%. Endometriosis should be suspected in any woman with infertility. In most cases, endometriosis is associated with severe painful periods (dysmenorrhea) characterized by sharp shooting pains during menses or sexual intercourse. In addition to being a very painful condition, in many cases, endometriosis can lead to infertility by causing pelvic adhesions, abnormal ovulation, and interference with the ability of the fallopian tube to pick up the egg from the ovary. Endometriosis may be associated with an increased risk of a miscarriage.
How does endometriosis cause infertility?
The exact mechnism for infertility in women with endometriosis is not clearly understood.
The following theories for infertility related endometriosis have been proposed:
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PELVIC ADHESIONS(scarring), can interfere with the release of eggs from the ovary
or with the ability of tube pick up the egg after its release from the ovary.
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IMMUNOLOGICAL FACOR- production of antibodies to the lining of the uterus(endometrium),
and interfering with the implantation of the embryo
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IMPAIRED IMPLANTATION OF THE EMBRYO- as a result of reduced level of an adhesive
like molecule(beta integrin)
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The only way to definitively diagnose endometriosis is by laparoscopy.  Sometimes the physician can feel nodules in the patient's pelvic structures which may be painful to touch and suggestive of endometriosis. An ultrasound may sometimes demonstrate an ovarian endometriosis cyst (chocolate cyst or endometrioma). A blood test for CA-125 is often elevated in patients with endometriosis and can be used to monitor the response to treatment. |
Laparoscopy is utilized to diagnose, stage and treat endometriosis. The disease can be classified as mild stage I endometriosis or as severe form stage IV disease. Intermediate endometriosis is usually classified as stage II or stage III. The treatment of endometriosis will depends on the extent of the disease, the age of the patient and whether or not infertility is an issue.
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WHAT ARE THE TREATMENT OPTIONS FOR ENDOMETRIOSIS?
- laparoscopic laser surgery to destroy the endometriosis and remove pelvic adhesions. When the endometriosis has not been completely resected surgically or for recurrent disease,
- suppression of ovulation with hormonal medications (oral contraceptives, progesterone or
GnRH agonists such as Lupron or Synarel)
is often utilized. A more promising medical therapy utilizing Aromatase Inhibitors
such as Letrozole or Anastrozole in combination
with Noretindrone Acetate or oral contraceptives is under evaluation.
Aromatase Inhibitors block the production of estrogen and therefore cause regression
of endometriosis in patients who did not respond to surgery. The advantage of this
treatment is that it is simpler, cheaper and associated with less side effects(such
as bone loss and hot flushes) as compared with Lupron.
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I HAVE ENDOMETRIOSIS AND WANT TO CONCEIVE, WHAT CAN I DO?
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Injectable hormone therapy
with artificial insemmination(gonadotropin therapy)
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In Vitro Fertilization (IVF)
is also used to help infertile women with endometriosis become pregnant in spite of their disease.
A nice "side effect" of pregnancy is that, since endometriosis
is exacerbated by ovulation, its absence during pregnancy and nursing can help to ameliorate the condition.
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