Endometriosis – Its Role in Female Fertility
Endometriosis is defined as the presence of endometrial-like tissue (glands and stroma) lining inside the uterus grows outside the uterus, which induces a chronic inflammatory reaction, scar tissue, and adhesions that may distort a woman’s pelvic anatomy.
- Endometriosis is generally found in young women, but the occurrence of endometriosis is not related to ethnic or social group
- Endometriosis is a very common debilitating disease that occurs in 6 to 10% of the general female
- About 25 to 50% of infertile women have endometriosis and 30 to 50% of women with endometriosis are infertile
- Common problems – dysmenorrhoea, chronic pelvic pain, deep dyspareunia, infertility
Mechanism
- Retrograde menstruation and implantation theory
- The coelomic metaplasia theory
- Immune system
- Direct transplantation of endometrial tissue
- Lymphatic dissemination of endometrial cells
How do I know if I have endometriosis?
- Dysmenorrhoea – pain during periods
- Dyspareunia – pain during intercourse
- Infertility
- Abnormal bleeding
- Cyclic bowel and bladder problem
- Chronic fatigue
Diagnosis
- USG, MRI
- Diagnostic laparoscopy – Laparoscopy with histopathological examination of the excised lesions is the gold standard for the diagnosis of endometriosis
Types of Endometriosis
How do I know what stage of endometriosis I have?
Endometriosis is classified into 4 stages according to American Society for Reproductive Medicine.
Does endometriosis cause infertility?
- Infertile women are 6 to 8 times more likely to have endometriosis than fertile women
- Several mechanisms have been proposed to explain the association between endometriosis and infertility
Mechanisms include
- Distorted pelvic anatomy – Major pelvic adhesions, peritubal adhesions, tubal patency which impaired oocyte release from the ovary and inhibit ovum pickup and transport.
- Endocrine and ovulatory abnormalities – Luteinized unruptured follicle syndrome, impaired folliculogenesis, luteal phase defect, premature or multiple luteinizing hormone surge
- Altered peritoneal function – Increase volume of peritoneal fluid with a high concentration of activated macrophages, prostaglandins, IL-1, TNF, proteases which adversely affects the functioning of the oocyte, sperms and fallopian tube and fimbrial failure to capture ovum.
- Altered humeral and cellular immunity factors modulate the growth and inflammatory behaviour of ectopic endometrial implants which affects embryo implantation.
How do I get rid of endometriosis?
Medical Management
Surgical Management
Effective, evidence-based treatments of endometriosis-associated infertility include conservative surgical therapy and assisted reproductive technologies such as IUI, IVF.
Dr Viza Swetha Reddy
MBBS, MD (OBG)
Consultant Obstetrician & Gynaecologist
OMNI Hospitals, Kurnool