Endometriosis is one of the more common causes of female factor infertility. It is when the endometrial tissue spreads outside of the uterus.
The tissue in the uterine lining swells, thickens and sheds with the other fluids during the menstrual cycle. When the tissue is outside of the uterine lining, it may attach to the lower abdomen, pelvic cavity, fallopian tubes or the outer surface of the uterine. During the menstrual cycle, it reacts the same, however it has nowhere to go. This can cause inflammation and scarring.
Endometriosis is diagnosed as a cause for female factor infertility in about one-third of cases. Some woman may never notice that they have endometriosis. Others may have severe pelvic pain and cramping during the menstrual cycle, unusual bleeding and pain during or after sexual intercourse.
The cause for endometriosis is unknown, but it is a treatable condition and most women are able to become pregnant following treatment.
Endometriosis does not need to be severe to cause infertility. Endometriosis can create an increased amount of white blood cells, a lowered immune system or organ damage causing one to be infertile. The scar tissue formed also has the potential to block the fallopian tubes, which may block the route of the embryo.
Physicians may suspect endometriosis following a pelvic exam or an ultrasound. An absolute diagnosis requires a visual evaluation through laparoscopy. This is an outpatient surgical procedure. Surgeons insert a laparoscope through a small incision below the navel. The laparoscope is a long and thin, flexible instrument used as a telescope to view the area.
During the procedure, the surgeon is able to destroy the endometriosis by using a laser or laparoscopic scissors. By removing the endometriosis, the pelvic environment is improved for pregnancy.
The non-surgical approach is through hormone therapy. Hormone medications will temporarily stop ovulation, allowing the endometrial lesions to shrink and prevent new implants from developing. It does not cure endometriosis, however, and it is possible it will return after treatment.
For women trying to become pregnant, laparoscopy is the recommended method of treatment with the higher pregnancy success rate.
In severe cases of endometriosis when the fallopian tubes are blocked with a large amount of scar tissue, the couple may consider assisted reproductive procedures like in vitro fertilization.
Endometriosis is a disorder in which the endometrial tissue lining the uterus begins to grow in another location in the body.
Surgery is often not needed for endometriosis much because better ways of achieving pregnancy, such as IVF are available. Minimal to mild endometriosis responds to non-IVF treatment while moderate to severe disease is arguably better treated with IVF.
Role of Surgery for Infertility
- Surgery can reduce pain to allow time for fertility treatment to succeed
- Surgery can improve outcomes: if IVF is not an option or the couple desires to try every possible means of avoiding IVF (and hopefully the woman is younger than 35 yrs)