Dr. John Park @ Carolina Conceptions

Endometriosis is a condition where the endometrium – the active tissue lining the inside of the uterus where an embryo would implant – is displaced outside of the uterus and grows in an abnormal location.  Endometriosis is a common cause of pelvic pain, painful periods, and infertility, but it is very difficult to diagnose.  There isn’t a blood test or imaging test available, so diagnosis must be made surgically by laparoscopy.  In laparoscopy, a small camera is inserted through the belly button into the pelvis to evaluate the pelvic organs and see if endometriosis is present.

Endometriosis doesn’t always cause infertility.  In fact, less that half of women with the condition have difficulty conceiving.  One of the ways endometriosis can cause infertility is by causing a distortion of the pelvic anatomy.  In some cases the endometriosis causes chronic inflammation and scar tissue formation, which can cause an obstruction in a fallopian tube.  These cases will be found when an HSG study is performed, and laparoscopy can be done to try to fix the fallopian tube.  At the same time, endometriosis can be diagnosed and surgically treated by excision or ablation with electrocautery.  After surgery to fix the fallopian tube, patients can either try to conceive on their own or immediately start fertility treatment.

It is also possible that endometriosis reduces fertility by impairing the quality of eggs and developing embryos.  It has been shown that donated eggs from women with endometriosis have lower implantation rates and lower embryo quality.  Most observational studies have shown that women with endometriosis have lower success rates with IVF.

When endometriosis is found during surgery, the severity of the disease is quantified by using a staging system.  There are 4 stages of endometriosis with stage 1 being minimal and stage 4 being the most severe.  This system is used to communicate the extent of disease, but the stage of endometriosis is actually poorly correlated with the severity of pelvic pain.  Some women with stage 1 endometriosis have more pain than women with stage 4. In fact, some women with stage 4 have no pain at all.

Higher stages of endometriosis are correlated with infertility, and women with stage 3 and 4 endometriosis often require aggressive treatment to conceive, such as superovulation with IUI or IVF. While endometriosis affects IVF results, IVF is the best way to maximize the chance of pregnancy in those with endometriosis, especially in those who have distorted pelvic anatomy due to the disease that cannot be corrected surgically.

Pregnancy outcomes in those with endometriosis appear to be negatively affected.  A large Swedish study followed almost 9,000 women with endometriosis and found an increased rate of preterm delivery, pre-eclampsia, and early bleeding/placental problems.

After achieving pregnancy, many women will notice an improvement in endometriosis symptoms such as pelvic pain or painful periods.  In pregnancy, the placenta produces a large amount of progesterone, which can suppress endometriosis.  This can result in a temporary improvement in symptoms, but they usually recur over time.

Women who are done with childbearing can continue using birth control or the Mirena IUD for the benefit of pain reduction. There are no vitamins/supplements/herbs, etc. that are proven to reduce pain. Pain is subjective. If a woman’s pain is affecting her quality of life, she needs to see her physician.

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