What is the Link Between Endometriosis and Infertility

For a condition that afflicts something like 5 million American women, Endometriosis is not very well understood by the medical community.  There is pretty solid agreement that a moderate to severe cases of endometriosis can be considered as as being one of the causes of infertility.  Endometriosis is a common cause of abdominal pain, pelvic pain,  in women.

Pain can increase during menses, urination, bowel movements and intercourse. Some women have endometriosis causing infertility with no associated pain. Many women have mild cases and suffer no ill effects and have no trouble getting pregnant.

What is this strange disease?  The term “endometriosis” comes from the name of the type of cells causing the disease, “endometrial cells.” Endometrium is the lining of the uterus that thickens during ovulation to prepare for the egg. Endometrial cells line the inner layer of the uterus and nourish a developing fetus. These cells are able to provide nutrients because they have the capacity to divide rapidly and increase in vascularity (more blood flow) under the influence of estrogen and progesterone.

During the monthly ovulatory cycle, levels of estrogen and progesterone increase leading to thickening of the uterine lining. If conception occurs, the corpus luteum (follicular structure that remains after ovulation) produces progesterone to further support the endometrium in sustaining a developing embryo. If conception does not occur, the vascular endometrial tissue is expelled during menstruation

For reasons that are not entirely known, sometimes this specialized tissue grows outside the uterus and attaches to other organs; this clearly is not desirable. Endometrial cells enter the body cavity or bloodstream and attach to organs or other structures. Once the endometrial cells attach, they retain their capacity to grow rapidly under the influence of estrogen. Endometrial cells can enter the bloodstream and have been found in virtually all parts of the body including the lungs, the bowel, attached to thefallopian tubes, the ovaries, etc. Their growth can damage, and in some cases, penetrate the host organ.

There are many theories as to the cause of endometriosis but the most popular states that endometrial cells enter the pelvic cavity as a “backflow” of blood during the menstrual cycle. It is also postulated that some women’s immune systems do not immediately identify and destroy the endometrial tissue. This helps to explain why there is a genetic link with daughters of women with endometriosis more likely to have the disease.

Mild cases are probably never diagnosed and cause no problems.  Some are of the opinion that up to 70% of those with mild cases will be able to conceive within three years with no treatment; however three years of trying is a long time.

More substantial levels of influence (the medical community has a rating system for the severity of the situation) can cause significant pain, damage and infertility.  One study reported a connection between endometriosis and infertility in 5-15% of cases, but another source placed this as the cause in 25% to 35% of infertile women.

The renegade tissue, growing outside the uterus, behaves like regular endometrium tissue, thickening and falling away during the cycle.  The fact that other parts of the abdomen are not equipped to deal with this, so that can cause other related problems with possible infection, etc.  As irritated portions heal and scar, the disease can actually bind organs together.  It can cause scarring in the fallopian tubes, which can reduce the mobility of the egg.

This can be a slowly progressive disease, gradually expanding within the abdominal cavity.  It can attach to ovaries and affect their ability to create and release healthy eggs.  Endometriosis located around the uterus can cause painful spasms and particularly difficult periods.

It seems that estrogen is involved in allowing or causing the tissue to grow where it is not welcome, so treatments sometimes center on controlling estrogen.  Medical treatments for the disease seek to lower estrogen levels. Too much estrogen can cause other complications that result in infertility as well.

It would be convenient if there were symptoms that made it easier to link endometriosis and infertility, but such is not really the case.  Some of the symptoms for this disease can also be related to other conditions, so if is sometimes mis-diagnosed.  However, some clues are (unusually) painful menstrual periods, abnormal bleeding and pain during sexual relations.  Chronic pain in the pelvic region, backache and leg pain, nausea, high blood pressure, diarrhea and other seemingly unrelated symptoms can actually be pointing to endometriosis.  Sometimes it is diagnosed as appendicitis, ovarian cysts and pelvic inflammatory disease (PID, another cause of infertility).

Treatments can vary widely, from hormone treatment to specialized drugs to surgery to remove the tissue.  The laparoscopy for fertility conditions, such as endometrial tissue removal, should be performed by a reproductive surgeon whenever possible. Specialists have extensive advanced microsurgical training and can keep the formation of scarring or adhesions to a minimum.

A visit to a specialist can help avoid the possibility of years of an incorrect diagnosis and improper treatment.  The treatment may differ for women who want to become pregnant compared to those who no longer plan to have children.  It is important to deal with the effects of endometriosis and infertility, but this condition should be treated even if pregnancy is not the issue.

The disease can reoccur even after treatment.  And it is important to obtain a proper diagnosis in the first place.  The actual course of action will be decided by the specialist depending on several factors, including personal history and health and the stage of severity.