Endometriosis is a common cause of infertility. Endometriosis affects 5-10% of women causing pelvic pain, severe cramping with menses, painful urination, painful and possibly bloody bowel movements, pain during intercourse, and infertility. It is estimated that endometriosis is present in 38-50% of all infertile women, and in 70-80% of women with chronic pelvic pain.
Every month the lining of the uterus, the endometrium, thickens and becomes more vascular in order to support the implantation of an embryo, and fetal development. The cells lining the uterus (endometrial cells) have the capacity to grow and divide rapidly to cause this thickening.
Endometriosis occurs when endometrial cells enter the pelvic cavity and attach to the reproductive and other organs and continue to grow. Endometrial cells can enter the bloodstream, or the lymphatic system, and endometriosis has even been reported in the lungs and brain.
Endometriosis can cause damage and blockage of the fallopian tubes and attach to the ovaries and other reproductive organs. Endometriosis is “foreign” to the pelvic cavity so the body can mount an immunologic attack to destroy it, thus creating an inflammatory environment in the pelvis.
There are different theories on the cause of endometriosis. The incidence of endometriosis is higher in daughters of mothers who had endometriosis suggesting a genetic link. The most commonly accepted theory is that menstrual blood “back flows” into the pelvic cavity at the end of the ovulatory cycle. This blood is very rich in endometrial cells.
Endometriosis needs estrogen to support its growth and survival. Therefore, the most common medical treatment is leuprolide acetate (Lupron). Lupron lowers estrogen levels by competing with binding sites at the hypothalamus.
Endometrial implants are sometimes removed surgically by laparoscopy. Reproductive Care Center's reproductive surgeons are board certified in reproductive endocrinology and infertility and have extensive laparoscopic surgical experience. One advantage of selecting an infertility specialist to perform the diagnostic laparoscopy is that oftentimes endometriosis can be treated during this procedure.