Endometriosis is a common cause of infertility and is often accompanied by severe menstrual cramps, painful bowel movements or urination, pain during intercourse, and pelvic pain. Endometriosis may cause no pain yet still cause infertility.
Endometriosis occurs when cells that line the uterus (endometrium) attach to organs such as the ovaries and intestine. The endometrium must thicken and become more vascular to accept and support a developing embryo. This thickening is accomplished by rapid division of endometrial cells under the influence of the hormones estrogen and progesterone. Endometrial cells retain their ability to divide when they enter the pelvic cavity.
Endometrial cells are dependant upon estrogen for growth, which is why
Lupron is an effective treatment. Lupron inhibits the production of FSH and LH leading to lower levels of estrogen, thus “starving” the endometrial cells.
Endometriosis is believed to be due to “back flow” of menstrual blood, rich in endometrial cells, into the pelvic cavity during menses. It may also have an immune component because antibodies normally destroy these cells. There is believed to be a genetic component as well, since children of women with endometriosis are more likely to have the disease.
When endometriosis attaches to reproductive organs, such as the fallopian tubes, it can cause obstruction or total blockage. Small amounts of endometriosis are believed to inhibit successful reproduction by creating an inflammatory environment in the pelvic cavity.
This is why it is critically important to remove all of the endometrial lesions at the time of laparoscopy. In general, a
laparoscopy for infertility should be performed by a reproductive endocrinologist. These specialists have years of advanced training in delicate microsurgical techniques and can often treat endometriosis during laparoscopy with a carbon dioxide laser. This eliminates the need for a second laparoscopy.
If you have endometriosis, your fertility treatment will depend upon the extent of your disease and other factors. Lupron may be effective if you have pain after laparoscopy or if all lesions cannot be safely removed, or if you have a recurrence of endometriosis symptoms. Where damage to reproductive organs, such as the fallopian tubes is severe,
IVF may be the best treatment option.