Endometriosis and Infertility


What is endometriosis?

Presence of Endometrium (Lining of uterus) outside the uterus is called Endometriosis.

It is a condition that results from growth of uterine tissue outside the uterus. It is a benign (not cancerous) condition but invades local tissues like ovaries, fallopian tubes, bowel etc. At times Endometriosis is very fast growing and also spreads and disseminates widely to surrounding tissues.

Is Endometriosis caused by hormone imbalance?

No, but growth of Endometriosis is promoted by cyclic hormones. Therefore Endometriosis is only seen in reproductive age group and not in menopausal women.

The exact cause of endometriosis is not completely known. However it does seem to be hereditary indicating that there could be many genes involved.

How common is endometriosis?

Endometriosis affects one in 10 women in reproductive age group (15-45 years) and approximately 50 % of infertile women. In one recent study amongst all women those who visited hospital for long standing pelvic pain, 75 % were diagnosed to have Endometriosis.

What are sites of endometriosis?

Endometriosis can affect following sites:

Tubes, Ovary (In ovary it causes endometriotic cyst; also known as Chocolate Cyst of ovary), peritoneum, bladder, bowel and even remote sites like lung. Practically endometriosis can involve any and every site.

What are the symptoms of endometriosis?

Usually endometriosis symptoms are not very pronounced, endometriosis causes pain in lower abdomen, painful intercourse, painful menstrual cycles and if it has spread to bladder, pain during urination and discomfort during bowel movement.

The symptoms of endometriosis do not correlate with the extent of disease. At times a woman might have very few symptoms in spite of having widespread disease and on the other hand, some might have severe pain and very mild disease.

How is endometriosis diagnosed?

Endometriosis diagnosis can be tricky. Usually Endometriosis is diagnosed by an infertility specialist on the basis of history, clinical examination and investigations. Ultrasound is of very limited use and will only diagnose endometriotic cysts in the ovary.

Laparoscopy is considered to be the gold standard for diagnosing endometriosis. The advantage of doing laparoscopy in suspected cases is that endometriosis can be treated as well in the same sitting – Also known as confirm and treat.

Does measurement of  CA-125  help in  diagnosis of Endometriosis?

According to recent guidelines, CA-125 should not be used to diagnose or to track progress of endometriosis.

Can Endometriosis cause Infertility? Can endometriosis delay conception?

Yes. Endometriosis can cause an alteration in the anatomic relationship between fallopian tube and ovary and therefore may cause infertility.
Endometriosis also causes adhesions and scarring around the fallopian tubes. This can also impair tubal function.
In cases where ovarian endometriotic cysts occur, ovarian reserve can be compromised because of the invasive nature of the cyst, may cause fall in AMH levels and this may further reduce the chances to become pregnant.    
Research also shows that endometriosis causes an alteration in the biochemical environment around the tubes and ovary. This reduces the chances of implantation of the embryo.
In short, there are multiple pathways through which endometriosis causes infertility and about 50% of infertile women are diagnosed with endometriosis.

Is Adenomyosis same as Endometriosis ?

Not exactly. Uterus is a layered organ. Adenomyosis is a condition when the outer most layer of the uterus i.e. endometrium grows deeper and spreads to the inner layer of uterus called myometrium. This causes thickening of the uterine wall and may enlarge the uterus and result in abnormal bleeding. Both these conditions are different but at times share common symptoms.

Can endometriosis cause misscarriage?

Endometriosis can increase the the risk of miscarriage in those who conceive spontaneously. There are studies which show that women who have endometriosis have an 80% higher chance of having a miscarriage than those who do not have the disease.

I am planning IVF, does endometriosis affect the quality of my eggs?

If endometriosis affects the ovary causing cyst formation (also known as endometriotic cyst or chocolate cyst of ovary), it destroys surrounding normal ovarian tissue which results in reduced ovarian reserve and lesser number of oocytes retrieved during an IVF cycle. It also affects the quality of oocytes in ivf cycle and results in a reduction in success rate of the ivf treatment.

What is the treatment of endometriosis? 

Pain and pain related symptoms related to chronic endometriosis are taken care of by simple pain killers.

If pain is not controlled, in cases where pregnancy is not desired, oral contraceptive pill can be given. This can be continued for as long as the patient does not want to become pregnant.

In those patients presenting with infertility and endometriosis, becoming pregnant as soon as possible is the best approach. Laparoscopy followed by IVF or even IVF if required can be considered.

Does surgery help in treatment of endometriosis?

In some cases where pain is severe, surgery along with medicines can temporarily relieve symptoms. Surgery is also done in cases of large endometriotic cysts. As far as a permanent solution for endometriosis is concerned, it is best to achieve pregnancy as soon as possible as pregnancy is the best natural way to cure endometriosis.

Pregnancy and breastfeeding are good for the disease as the hormone suppression will lead to less pain and even causes resolution of adhesions.

Endometriosis can significantly impact the Quality of your Life!



You might want to read