Endometriosis is a condition affecting women, where tissue like the tissue that normally grows inside the uterus (endometrium), also grows outside the uterus. It can grow in the ovaries, fallopian tubes, bowel, and bladder. This condition can cause pain (pelvic pain during or between menstrual periods, during sexual intercourse, with bowel movements or while urination) and/or difficulty getting pregnant (infertility).
Adenomyosis is a special type of endometriosis in which tissue lining the uterus grows into the wall of the uterus, causing pain, abnormal bleeding and reproductive failures such as miscarriages, difficulty getting pregnant (infertility) and IVF failures. It can increase the risk of pregnancy complications as preterm premature rupture of membranes and preterm delivery.
How endometriosis can be a cause of infertility?
Endometriosis can cause damage to the fallopian tubes or ovaries leading to scar tissue within the pelvis and blockage of the tubes, thus causing infertility for some women. However, some women with endometriosis don’t have scar tissue or tubal blockage and they still can’t get pregnant.
In addition to the damage created by endometriosis, there is evidence that the hormonal (endocrine) and immune system in patients with endometriosis are not functioning properly which can lead to unexplained infertility, repeated IVF failure and miscarriages. Endometriosis is associated with inflammation within the pelvis, creating an unhealthy environment for ovulation, fertilization and pregnancy implantation.
How to know if I have endometriosis? And how to treat it to get pregnant?
Surgery and possibly taking a sample from the pelvis lining is the only way to confirm the diagnosis, however, this is seldom needed and most of the physicians diagnose it based on the clinical picture (symptoms of pain and physical exam).
Treatment of women with endometriosis depends on the goals, Patients who want to be treated for infertility might follow a different approach from those who want to relieve the pain.
The following are possible treatment options for infertility women with endometriosis:
- Fertility medications such as Clomiphene (Clomid) and Letrozole (Femara) with or without intrauterine insemination.
- In vitro fertilization (IVF) might be needed for some patients and usually performed by an IVF specialist
- Some patients might benefit from a short course of Gonadotropin-releasing hormone agonists (GnRH) to stop the ovaries from producing estrogen hormone temporarily and cause the endometriosis implants to shrink. Estrogen is the hormone feeding the endometriosis.
- Surgery to diagnose and removal of endometriosis in some cases.
How Reproductive Immunology can help me?
In addition to the above treatment modalities, immune testing will be performed to check if there are any abnormalities within the immune system or inflammation that can lower the success rate of the above infertility treatment. Based on test results, an immune protocol might be added to the infertility treatment plan to modulate the immune system.