How Endometriosis Affects Conception by Dr. Mike Berkley

Endometriosis and Conception

Endometriosis is a common, yet poorly understood disease. It can strike women of any socioeconomic class, age, or race. It is estimated that between 10 and 20 percent of American women of childbearing age have endometriosis.

While some women with endometriosis may have severe pelvic pain, others who have the condition have no symptoms. Nothing about endometriosis is simple, and there are no absolute cures. The disease can affect a woman's whole existence--her ability to work, her ability to reproduce, and her relationships with her mate, her child, and everyone around her.

What is Endometriosis?

The name endometriosis comes from the word "endometrium," the tissue that lines the inside of the uterus. If a woman is not pregnant, this tissue builds up and is shed each month. It is discharged as menstrual flow at the end of each cycle. In endometriosis, tissue that looks and acts like endometrial tissue is found outside the uterus, usually inside the abdominal cavity. Endometrial tissue residing outside the uterus responds to the menstrual cycle in a way that is similar to the way endometrium usually responds in the uterus.

At the end of every cycle, when hormones cause the uterus to shed its endometrial lining, endometrial tissue growing outside the uterus will break apart and bleed. However, unlike menstrual fluid from the uterus, which is discharged from the body during menstruation, blood from the misplaced uterus has no place to go. Tissues surrounding the area of endometriosis may become inflamed or swollen. The inflammation may produce scar tissue around the area of endometriosis. These endometrial tissue sites may develop into what are called "lesions," "implants," "nodules," or "growths."

Endometriosis is most often found in the ovaries, on the fallopian tubes, and the ligaments supporting the uterus, in the internal area between the vagina and rectum, on the outer surface of the uterus, and on the lining of the pelvic cavity. Infrequently, endometrial growths are found on the intestines or in the rectum, on the bladder, vagina cervix, and vulva (external genitals), or in abdominal surgery scars, Very rarely, endometrial growths have been found outside the abdomen, in the thigh, arm, or lung.

Physicians may use stages to describe the severity of endometriosis. Endometrial implants that are small and not widespread are considered minimal or mild endometriosis. Moderate endometriosis means that larger implants or more extensive scar tissue is present. Severe endometriosis is used to describe large implants and extensive scar tissue.

What are the Symptoms?

Most commonly, the symptoms of endometriosis start years after menstrual periods begin. Over the years, the symptoms tend to gradually increase as the endometriosis areas increase in size. After menopause, the abnormal implants shrink away and the symptoms subside. The most common symptom is pain, specially excessive menstrual cramps (dysmenorrhea) which may be felt in the abdomen or lower back or pain during or after sexual activity (dyspareunia). Infertility occurs in about 30-40 percent of women with endometriosis.

Rarely, the irritation caused by endometrial implants may progress into infection or abscesses causing pain independent of the menstrual cycle.

Endometrial patches may also be tender to touch or pressure, the intestinal pain may also result from endometrial patches on the walls of the colon or intestine. The amount of pain is not always related to the severity of the disease. Some women with severe endometriosis have no pain; while others with just a few small growths have incapacitating pain.

Endometrial cancer is very rarely associated with endometriosis, occurring in less than 1 percent of women who have the disease. When it does occur, it is usually found in more advanced patches of endometriosis in older women and the long-term outlook in these unusual cases is reasonably good.

How is Endometriosis Related to Fertility Problems?

Severe endometriosis with extensive scarring and organ damage may affect fertility. It is considered one of the three major causes of female infertility.

However, unsuspected or mild endometriosis is a common finding among infertile women. How this type of endometriosis affects fertility is still not clear.

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BIO:

Dr. Mike Berkley is the founder and director of The Berkley Center for Reproductive Wellness, in New York. He works exclusively in the area of reproductive medicine and enjoys working in conjunction with some of New York’s most prestigious reproductive endocrinologists. Sign up for his free newsletter at www.BerkleyCenter.com

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