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Endometriosis is a very common cause of female infertility, but it can also cause other gynecologic symptoms such as painful periods, pain during intercourse, and painful bowel movements.
Unlike many conditions, however, the severity of endometriosis does not necessarily match the severity of the pelvic symptoms. Thus, it is possible that the only symptom of endometriosis may be infertility without pelvic pain, or alternatively, some patients with minor endometriosis can be extremely symptomatic.
Endometriosis occurs when cells that normally line the uterus, called the endometrium, enter the abdomen and attach to organs such as the ovary, tube, or bowel. These cells can then grow in response to female hormones such as estrogen.
While many theories exist as to how it develops, the exact cause of endometriosis is unknown. The most widely accepted theory is that the endometrial cells flow backward through the tubes into the abdomen, instead of all going forward into the vagina in the form of the menses. Again, many different explanations have been proposed as to how these ”transplanted” endometrial cells in the abdomen can cause pain and infertility.
One thing that seems certain is that these cells can cause the abdomen to mount an inflammatory response. In its most severe form this inflammation can lead to scarring (adhesions). This scarring can lead to infertility by mechanically blocking the transfer of the eggs from the ovary to the tube and can also lead to pelvic pain.
The two main treatments for endometriosis are medical or surgical. Medical treatments focus on altering the hormonal environment of endometriosis, thus, slowing or halting its growth.
Hormonal treatments such as birth control pills or progesterone seem to improve the pain symptoms associated with endometriosis. Another medication called Lupron is sometimes necessary to control the symptoms.
Unfortunately, these treatments do not typically eliminate the endometriosis, but rather they cause regression on the endometriosis with diminution of the symptoms. It will not, however, remove the scar tissue that has already developed. Furthermore, on these medications it is not possible or advisable to conceive.
An alternative treatment would be surgical. The surgery is usually minimally invasive and thus treatment can occur on an outpatient basis with quick recovery times. This laparoscopic procedure is accomplished through small (1/2 inch) incisions. When combined with carbon dioxide laser, it can be just as effective and at times superior to larger incisions in completely eliminating the endometriosis and/or scar tissue.
Once the pelvis has been restored to normal, patients will often return to a quality of life without pelvic pain issues, and can allow them to conceive naturally at home without the need for assisted reproductive technologies.
If IVF is needed research has shown it to be more successful in achieving pregnancy when the endometriosis has been treated.
We provide services for the diagnosis and treatment of infertility.
Our services include an outstanding IVF and donor egg program.
We offer all levels of treatment including infertility testing intrauterine insemination (IUI), medical treatment, and advanced laparoscopic surgery. Most of our patients become pregnant without requiring IVF.
Monday-Thursday 8AM - 5PM
Friday 8AM - 1PM
Our patients can reach us for emergencies 24 hours a day by calling our main number, and selecting choice #1, which pages our medical or nursing staff.
If your situation is life threatening, dial 911 or go directly to your local ER.