Endometriosis is a gynecologic disorder that affects about 6-10% of reproductive age women and is present in about 38% of infertile patients. There are roughly 176 million women that have endometriosis. It mainly presents itself with chronic pain and infertility. There is some evidence that endometriosis has a familial association and patients with an affected first-degree relative have an about a 7-10 fold increase in developing endometriosis.
The mechanisms causing endometriosis are complex, but it is thought to be due to the attachment and implantation of endometrial tissue on the pelvis and pelvic organs, which then results in an inflammatory response. Endometriotic lesions can also implant on the bladder and bowel, and can form ovarian cysts called endometriomas.
A definite diagnosis can only be made by evaluating lesions removed at surgery but a presumptive diagnosis can be made in patients presenting with chronic pelvic pain, significant pain with periods (dysmenorrhea) and pain during intercourse (dyspareunia). Bowel and bladder symptoms can also be present. However, a significant number of patients are asymptomatic.
Symptomatic patients can be treated with pain medication as well as medical suppressive therapies such as oral contraceptive pills. The decision whether or not to proceed with surgery, such as laparoscopy, to further evaluate the patient for endometriosis should be made on a case-by-case basis.
The factors contributing to infertility in patients with endometriosis are thought to be due to abnormal sperm and oocyte function caused by an abnormal peritoneal environment as well as anatomic abnormalities such as adhesions and endometriomas. Antimüllerian hormone, a marker of ovarian reserve, is often decreased in patients with endometriosis. Patients with infertility and suspected or proven endometriosis need to be evaluated carefully with ovarian reserve testing, pelvic ultrasound and testing for fallopian tube status. The treatment plan is then tailored to each patient’s needs. The Doctors at the Dominion Fertility Clinic have been very successful in treating endometriosis and infertility. Feel free to give us a call if you have any questions or would like to set up a consultation appointment.
Dr. Susan Sarajari
Ref: Management of Endometriosis. ACOG Practice Bulletin. #114. July 2010.