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Endometriosis and Infertility

Endometriosis refers to the presence of uterine (endometrial) cells outside of the uterus. These cells can cause many symptoms, including painful cramps, lower back pain, pain during intercourse, and even pain when urinating or during bowel movements. Often symptoms wax and wane with the menstrual cycle, as these cells respond the same way uterine cells do to variations in hormone levels.

As if pain in itself were not enough, endometriosis and infertility can be linked to each other. In the first place, chronic pain or pain during intercourse obviously does not increase the likelihood of a couple fertilizing an egg. In addition, as these cells grow outside the uterus, the body tries to protect itself by surrounding them with a fibrous tissue, or scar tissue. The growth of these tissues can cause organs to actually become “stuck” together. For example, an endometrial growth at the top of the uterus, may end up becoming attached to the ovary and small intestine, as well.

In terms of infertility, endometrial growths and their accompanying scar tissue can have many effects. One is to cause the fallopian tubes and ovaries to either adhere to the pelvic lining or to each other, restricting their movement or function. The growths can actually pinch off the fallopian tube, or block the opening to the tube from the uterus, thereby preventing the union of egg and sperm. In addition, even if conception occurs, blockage of the tube might cause an ectopic pregnancy, in which the embryo cannot reach the womb to implant.

Another factor linking endometriosis and infertility is the presence of prostaglandins, hormones which have a key role in regulating the menstrual cycle, ovulation, and other uterine functions.

With endometriosis, the endometrial cells act just like uterine cells, releasing these hormones. However, not only does this cause an excessive amount of prostaglandins, and their release into areas besides the uterus (i.e., the abdomen), but the endometrial cells do not always act “in sync” with the uterine ones, causing menstrual cycles and implantation processes to become irregular, provoking contractions and unfavorable conditions for pregnancy – in other words, early miscarriage – sometimes so early the woman does not even realize she was pregnant. It is estimated that as many as 40% of women with endometriosis can have issues with infertility.

In order to diagnose endometriosis, laparoscopy is often utilized. Under general anesthesia, your doctor will insert a thin, fiber-optic telescope into your abdominal cavity, allowing the examination of your fallopian tubes, ovaries, and uterus. If endometriosis and/are scarring are identified, another laparoscopy procedure can be performed to remove the irregular tissue. Many women have success in becoming pregnant in the six to nine months following the procedure.

Another option is to use an in vitro fertilization (IVF) procedure, which allows the sperm and egg to be combined in a laboratory setting before implantation, thereby removing at least one of the stumbling blocks to conception that occurs with endometrial blockages.

Endometriosis does not necessarily mean that it is impossible to become pregnant – but it can make it more difficult. If you experience any of the symptoms above, or simply have more questions, be sure to contact your doctor.

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