Endometriosis is the abnormal growth of tissue that normally lines the uterus (womb) in regions outside the uterus – this can be on ovaries, fallopian tubes, as well as on the intestine and bladder. The displaced tissue irritates the surrounding structures, leading to pain during menstrual flow or intercourse, and scar-formation (adhesions). The exact cause of this condition is not clear, but one theory is that when the uterine tissue (endometrium) gets discharged during menstrual flow, some of the cells move back towards the fallopian tubes and attach to organs outside the uterus.
Endometriosis is a major cause of infertility in women, holding a 50% stake in this association.1 The reason for this link is again ambiguous but can be attributed to certain physical (scar tissue) and chemical (substances released by the endometriosis) hindrances to the release and fertilization of the egg and sperm, and its effect on the quality of the eggs and sperm present in the woman’s reproductive tract.
Diagnosis of endometriosis is important, not only to determine the cause of pelvic pain, but to also stage the condition (Stage 1 to 4) according to severity, which helps determine a woman’s risk for infertility. Women with stage 4 endometriosis have damaged ovaries and blocked tubes, facing the highest level of infertility and requiring advanced fertility treatment.
There are many approaches to treating infertility associated with endometriosis. Laparoscopic surgery to remove scar tissue and other obstructions shows considerable success for conception in women suffering from mild-to-moderate endometriosis. It resumes the normal structure of the reproductive tract and allows the organs to function better. Controlled ovarian stimulation (COS) along with intrauterine insemination (IUI), where egg release is stimulated and healthy sperm are injected into the uterus, is another option that can enhance fertility. More aggressive treatment with in vitro fertilization (IVF) is usually indicated in older women trying to conceive with endometriosis. Treatment is highly individualized and is based on many factors such as stage of disease, age of woman and duration of infertility.