Endometriosis

Endometriosis is a common cause of infertility in women and occurs when cells that normally line the uterus (endometrium) attach to reproductive, and/or other organs. The primary theory as to the cause of endometriosis is that endometrial cells “back flow” with menstrual blood entering the blood stream and lymphatic systems. Endometrial implants have been reported throughout the body even in distant areas like the lungs and brain. There is also a genetic component wherein daughters of women with endometriosis have a higher incidence of the disease.endometriosis

The genetic component is most likely “immune related”. Normally, the body’s immune system recognizes endometrial cells as “foreign invaders” and destroys them. Endometrial cells “escape” this immune system protection in women with the disease. The endometrial cells can attach to reproductive structures, such as the fallopian tubes or ovaries, causing damage, obstruction, and infertility.

Symptoms of endometriosis include pain during urination and bowel movements, pain during intercourse, abnormally heavy periods, abdominal pain, and infertility.

Endometrial cells line the uterus and they have the capacity to rapidly grow and divide under the influence of the hormones progesterone and estrogen. This growth is needed for the endometrium to become more vascular and thicken to support an implanting embryo. The cells retain this capacity to divide and multiply when attached to other organs.

Because of endometrial cells need for estrogen, medical treatment involves administration of drugs like Lupron. These drugs block the body’s natural production of estrogen thus “starving” the endometrial cells. Unfortunately, these drugs induce a “menopausal state” with all the accompanying side effects including hot flashes, mood swings, and others.

Endometriosis is often removed surgically using the laparoscope. The diagnostic laparoscopy for infertility should always be performed by a skilled reproductive endocrinologist. These specialists undergo years of training in advanced microsurgical techniques such as removal of endometriosis. Endometriosis discovered during the diagnostic laparoscopy can often be removed avoiding the need for a future “treatment laparoscopy”.