Endometriosis Risks and Treatments

Endometriosis (en-doe-me-tree-O-sis) is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus (endometrial implant). Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region. The Fertility Center of Charleston will assess each patient who might suffer from endometriosis and formulate an individualized fertility treatment plan.

Endometriosis Risk
Endometriosis is a common gynecological condition that affects 7-10% of women in the general population, and is seen in 38-50% of infertile women, and in 71-87% of women with chronic pelvic pain. The disorder is usually initially detected during the teenage years and peaks around the age of 40 years.

Endometriosis occurs when the cells that normally line the uterus (endometrium) enter the pelvis or bloodstream and attach to other organs. Endometrial cells have been seen in areas as distant as the lungs and brain, although they most commonly occur in the pelvic area. These endometrial implants can grow and damage the structures that they are attached to, leading to organ dysfunction. Endometriosis is often found on the fallopian tubes and can penetrate and obstruct these delicate structures. Unfortunately, it can also damage the ovaries, decreasing the ability to produce good quality eggs and causing early diminishing ovarian reserve.

Many theories about the cause of endometriosis focus on the possibility that this disorder represents a state of an impaired immune system, which allows the endometrial implants to invade and proliferate. Biopsies of endometriosis contain high levels of macrophages, which contain cytokines and prostaglandins. These factors produce inflammation and damage the surrounding tissues.

There is a 10-fold increase in the incidence of endometriosis in women who have a mother or a sister with this disorder suggesting a potential genetic factor.

Incidence is 6-10% in general population
40-60% in women with dysmenorrhea
33% of women with pelvic pain
30-45% of women with infertility
Begins in teenage years and peeks at age 40
To gain more information on general endometriosis, call our office today at 843-881-7400 to schedule an appointment with Dr. Singleton.

Causes of Infertility in Endometriosis
There is no single cause of infertility in endometriosis but rather several factors that decrease the chances for conception. In advanced endometriosis (Stage III-IV), endometriomas (chocolate cysts) or pelvic adhesions interfere mechanically with ovulation and egg/embryo transport. In early endometriosis (Stage I-II), the mechanism of infertility is less clear and more complex. Consequently, infertility in women with endometriosis is relative, which means that some women are able to conceive.

Chances for Pregnancy – With Fertility Treatment
Some patients with endometriosis may increase their chances of pregnancy with conservative methods such as ovulation induction and intrauterine insemination, however, many women with endometriosis benefit from in vitro fertilization therapy. When fertility drugs are combined with in vitro fertilization/embryo transfer (IVF/ET) procedures, pregnancy rates are even higher than with ovulation induction and intrauterine insemination. It appears that in endometriosis during the IVF/ET cycle, replacement of the adverse intraperitoneal environment with controlled ‘in vitro’ conditions of the laboratory corrects the majority of anti-fertility effects of the disease.

Egg Freezing is a helpful option for those women with endometriosis not yet ready to start a family
Endometriosis can damage the ovaries and decrease the ability to produce good quality eggs at an earlier age than normal. Women with rapidly progressing endometriosis who are not in a position to begin their families may benefit from cryopreservation of eggs for future fertilization and pregnancy. This approach offers women with endometriosis, career women who wish to delay childbirth, couples troubled by freezing embryos, and for those facing treatments that will affect their fertility, a chance for cryopreservation and storage of their eggs until they are ready to start a family.