Endometriosis and Infertility
Endometriosis is a common cause of infertility and it is often accompanied by painful menses and pain during bowel movements, urination, or intercourse. Endometriosis occurs when the cells that normally line the uterus (endometrial cells) enter the pelvic cavity and attach to organs and other structures.
The endometrial implants continue their growth resulting in blockage, damage, and/or penetration of the organ/structure. Endometrial cells can travel through the lymphatic or circulatory systems and have been identified in organs as distant as the lungs and brain.
Endometrial cells are unique in that they have the ability to divide rapidly and proliferate under the influence of the hormones estrogen and progesterone. This characteristic is very important since these cells line the uterus and supply the developing embryo with nourishment. Endometrial growth accelerates during the luteal phase of the menstrual cycle stimulated by the hormone progesterone.
The commonly accepted theory of endometriosis’s cause is that endometrial cells enter the pelvic cavity through the fallopian tube during menstruation. Normally these cells are destroyed by the immune system, but in patients with endometriosis they implant and begin to grow. Therefore, there is probably a genetic component contributing to the disease. Daughters of women with endometriosis have a much higher incidence of the disease.
Endometrial cells can attach to organs including the ovaries, fallopian tubes, uterus, bowel, and virtually any other internal structure. Once attached they continue to grow and can penetrate the organ or cause blockage, as with the fallopian tubes. Endometrial growth also creates an “inflammatory environment” in the pelvic cavity that may negatively impact reproduction.
Treatment of endometriosis may involve laparoscopic surgery to remove the implants and/or medical therapy with products such as birth control pills, Aygestin, or Lupron. Birth control pills and Aygestin contain progesterone, which directly competes with estrogen. Lupron competes with gonadotropin releasing hormone and ultimately results in lower estrogen levels. Since endometrial implants rely upon estrogen for growth and nourishment, lower estrogen levels can stop their growth, and in combination with the immune system, lead to endometrial cell death.
Gynecologists and Reproductive surgeons undergo years of advanced training in delicate microsurgical techniques. Often, a skilled surgeon can remove the majority of the endometrial lesions during the laparoscopy. Consult with either your gynecologist or our office if you feel you need to pursue surgery.