endometriosisEndometriosis, a cause of female infertility, is a condition in which endometrial tissue, the tissue that lines the inside of the uterus, grows outside the uterus and attaches to other organs in the abdominal cavity such as the ovaries and fallopian tubes. Endometriosis is a progressive disease that tends to get worse over time and can reoccur after treatment. Symptoms include painful menstrual periods, abnormal menstrual bleeding and pain during or after sexual intercourse.

The endometrial tissue outside your uterus responds to your menstrual cycle hormones the same way the tissue inside your uterus responds – it swells and thickens, then sheds to mark the beginning of the next cycle. The blood that is shed from the endometrial tissue in your abdominal cavity has no place to go, resulting in pools of blood causing an inflammation that forms scar tissue. The scar tissue can block the fallopian tubes or interfere with ovulation. Another result of endometriosis is the formation of ovarian cysts called endometrioma that may also interfere with ovulation.

The cause of endometriosis is unknown though there are a few theories that suggest possible causes. One theory suggests that during menstruation, some of the menstrual tissue backs up through the fallopian tubes into the abdomen where it implants and grows. Another theory indicates that it is a genetic birth abnormality in which endometrial cells develop outside the uterus during fetal development.

A laparoscopy, an outpatient surgical procedure, is necessary to confirm a diagnosis of endometriosis after a medical history review and pelvic exam. After the initial diagnosis, your physician will classify your condition as stage 1 (minimal), stage 2 (mild), stage 3 (moderate) or stage 4 (extensive) based on the amount of scarring and diseased tissue found. Based on the stage of endometriosis, your physician will determine the best treatment plan for you which may include medication or surgery, or a combination of both.

Infertile patients with endometriosis of every grade, always have the options for IVF. Most of the studies suggests that women with endometriosis and infertility have the same IVF success rates as those with infertility due to damage in the fallopian tubes.

According to the research reported in the medical journal Reproductive Biology and Endocrinology,(1) a study of 428 women revealed that the women with ovarian endometriosis infertility were more likely to have a canceled cycle, but once IVF was performed they had the same pregnancy, implantation and delivery outcomes as their counterparts.

Furthermore, women with endometriosis infertility who had underwent laproscopy surgery to remove the endometriosis prior to surgery had no improved IVF success rates and even showed a decrease in ovarian response to fertility medications.

These findings suggest that perhaps endometriosis may not be as negative of a factor on IVF success rates as previously believed and therefore surgical interventions for endometriosis infertility treatment prior to an IVF treatment should be reconsidered.

1. Reproductive Biology and Endocrinology 2011, 9:81

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