Do I have endometriosis and is it important?
Endometriosis is a medical condition, in which the cells from the lining of the uterus (endometrium) grow outside the womb, most commonly in the lining of the pelvic cavity. It can also occur in the muscle of the womb (adenomyosis) or can lead to blood-filled cysts on the ovaries (endometrioma).
While it sounds ominous, endometriosis is relatively common, especially as women grow older. In some studies up to 40% of women have it. It is perhaps most well known for causing pelvic pain (painful periods, painful sex, or continuous discomfort. If there is no pain, some women might not even be aware that they have the condition. However, the other main symptom is infertility. It does this in a number of ways. It creates an inflammatory ‘toxic’ environment in the pelvis which can affect fertilization, it can cause tubal blockage or abnormal function (preventing sperm from reaching the eggs), it may affect egg quality, and it may affect the lining of the womb to reduce the chance of implantation. The only definite method of diagnosis is by day-case keyhole surgery called laparoscopy. Whilst this is quite an invasive procedure, endometriosis can be removed or burnt away at the time of laparoscopy, and this can double the chance of natural conception.
As with all fertility problems, the presence and treatment of endometriosis needs to be managed in the context of other factors too (such as sperm numbers and quality, and a woman’s age). Sometimes IVF is the quickest and easiest approach as it bypasses the pelvis and surgery (laparoscopy) can be avoided. Pregnancy is a good state for endometriosis as it keeps it suppressed. While surgery can be beneficial, the decision to operate should be done carefully, as extensive surgery of the ovaries can lead to loss of significant numbers of eggs and this can have a big impact of overall reproductive chances.
Endometriosis can also influence the choice of IVF protocol and drug doses, and IVF success rates are slightly lower in women with severe endometriosis. Whilst research is still underway, endometriosis does not appear to be a significant cause of miscarriage.