Endometriosis

Endometriosis is derived from the word “endometrium,” which is the tissue that lines the uterus. Patients with endometriosis have endometrial-type tissue outside of the uterus

Where Endometriosis Can Occur

The most common sites of endometriosis include: ovaries ,fallopian tubes outer surface of the uterus, intestines, rectum, bladder, scar tissue,peritoneum

Endometriosis Symptoms

Pain, especially excessive menstrual cramps that may be felt in the abdomen or lower back.

Pain during intercourse

Abnormal or heavy menstrual flow

Infertility

Painful urination during menstrual periods

Painful bowel movements during menstrual periods

Other gastrointestinal problems, such as diarrhea, constipation and/or nausea

Relationship of Endometriosis to Infertility

Endometriosis is considered one of the three major causes of female infertility. endometriosis can be found in 24 to 50 percent of women who experience infertility. In mild to moderate cases, the infertility may be temporary. In these cases, surgery to remove adhesions, cysts and scar tissue can restore fertility. In other cases — a very small percentage — women may remain infertile.

How endometriosis affects fertility is not clearly understood. It is thought that scar tissue from endometriosis can impair the release of the egg from the ovary and subsequent pickup by the fallopian tube. Other mechanisms thought to affect fertility include changes in the pelvic environment that results in impaired implantation of the fertilized egg.

In patients having infertility it can be diagnosed as an incidental finding while doing ultrasound(endometrioma )or laparoscopy (mild endometriosis or endometrioma). During laparoscopy, if there is an incidental finding of mild to moderate peritoneal endometriosis, or ovarian endometrioma, it should be treated. The most important thing is that if the endometriosis is associated with infertility then you might require treatment to hasten the process of pregnancy, using IUI or IVF. The main thing is to not to unnecessarily delay the process of pregnancy.

However, care must be taken to avoid damaging the ovary while removing an endometrioma. If the endometrioma is diagnosed during routine ultrasound it can be ignored and treatment can be carried out as per standard infertility workup. One can test for tubal patency, try 2 to 4 cycles of ovulation induction with IUI. If that fails, one can go directly for IVF.

However, in patients with very large endometriomas (which may come in the way of oocyte retrieval while doing IVF) or in patients with symptoms such as pain, one can go in with a laparoscope, drain the endometrioma, remove the capsule, taking care not to damage the ovarian tissue.