Endometriosis is present in approximately 40% of infertile women and is a common cause of pelvic pain. Women with endometriosis often experience severe pain during menses, when urinating, with bowel movements, and during intercourse. However, significant endometriosis can be present and produce no symptoms.
Endometriosis occurs when cells that normally line the uterus (endometrial cells) enter the pelvic cavity, attach to organs and multiply. The cells can obstruct the tubes or penetrate the ovaries and other structures. Endometriosis is not limited to the pelvis and endometrial implants have been identified in distant organs such as the lungs.
There are several theories as to the cause of endometriosis but most authorities believe that it is caused by a “back flow” of menstrual blood into the pelvic cavity during menstruation. Menstrual blood is rich in endometrial cells since it is formed from the breakdown of the uterine lining (endometrium). There also appears to be a genetic component since daughters of women with endometriosis have a higher incidence of the disease.
Endometrial cells depend upon the hormone estrogen for growth. Levels of estrogen rise around ovulation stimulating the uterine lining to thicken in preparation for the developing embryo. Reducing the amount of estrogen inhibits endometrial cell growth so drugs such as Lupron are effective in treating the disease. Lupron suppresses the production of FSH and LH which ultimately leads to lower estrogen levels.
Endometriosis is often removed surgically by laparoscopy, especially in infertility patients. If a laparoscopy is performed, it is very important that all endometriosis be removed as some authorities believe that small amounts can create an inflammatory environment in the pelvis. Many specialists prefer to move into aggressive infertility treatment such as ovarian stimulation with IUI or IVF rather than proceed to surgery. IVF success rates in patients with endometriosis are excellent.