ENDOMETRIOSIS

Endometriosis is a condition where tissue that normally lines the uterus begins to grow outside the uterus. This tissue can grow on any structure within the pelvic area including the ovaries, fallopian tubes and uterus. Endometriosis is the diagnosis for about 35% of infertile women who have no other diagnosable infertility problem. Endometriosis is found more commonly in women with infertility. Having Laparoscopic surgery is only way to determine if a woman has endometriosis. A Laparoscopy is a surgical procedure which is performed to diagnosis and treats adhesions or endometriosis. Laparoscopy is usually performed under general anesthesia, usually in a same-day surgery center. During the procedure, an instrument called a laparoscope is inserted through a small incision within or just below your nave. The physician then looks into the abdominal cavity and inspects the ovaries, fallopian tubes, and uterus. A dye is usually injected through the cervix to determine if the passage to the uterus and tubes is open. One or more additional smaller cuts may be made above your pubic area in order for the physician to insert additional instruments to better examine your pelvic organs and treat any disease if found. If a problem is found during the laparoscopic procedure, a variety of specialized surgical instruments, including lasers, may now be used to treat such conditions as endometriosis, adhesions, and ovarian cysts. Women with any stage of endometriosis (mild, moderate, or severe) can have severe lower abdominal and pelvic pain. Mild endometriosis can be associated with infertility in some women. Many fertile women also have mild endometriosis. No current studies show the relationship between the two.  It might be that infertility and delayed pregnancy predisposes women to developing endometriosis, rather than the endometriosis causing the infertility. Therefore, some experts consider infertility associated with mild endometriosis to really be "unexplained infertility". Severe endometriosis causes pelvic scarring and distortion of pelvic anatomy. The tubes can become damaged or blocked and the ovaries often contain cysts of endometriosis and may adhere to the uterus, bowel or pelvic side wall. Any of these distortions can result in infertility. In some cases the eggs in the ovaries can be damaged, resulting in decreased ovarian reserve and reduced egg quantity and quality. Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women. Some studies have shown that surgical treatment of severe endometriosis does improve the chances for pregnancy as compared to no treatment. Unfortunately, the infertility in women with severe endometriosis is often resistant to treatment with ovarian stimulation plus intrauterine insemination. If the pelvic anatomy is much distorted, artificial insemination would probably be futile at this point. These women will often require in vitro fertilization in order to conceive. If you have pain or bleeding from endometriosis and no plans to become pregnant, birth control hormones (patch, pills, or ring or an anti-inflammatory may be the answer to your problems in order to control pain. Birth control hormones help minimize endometrial tissue and reduce pain. They are also likely to keep endometriosis from getting worse by using anti-inflammatory drugs to reduce bleeding, inflammation, and pain. Most women can use these medicines long term with few side effects. If you have been experiencing more severe symptoms or if birth control hormones and anti-inflammatory drugs do not work, you might want to try a stronger hormone therapy such as gonadotropin-releasing hormone agonist (GnRH-a), progestin, a progestin intrauterine device or aromatase inhibitors. Some doctors may still want to do a laparoscopy to look for signs of endometriosis in the pelvis. References American Society for Reproductive Medicine. Infertility An Overview: A Guide for patients. Retrieved from: http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/infertility_overview.pdf Advanced Fertility Center of Chicago. The Effect of Endometriosis on Fertility and Infertility. Retrieved from:  

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