Endometriosis is a condition where the tissue which normally lines the uterus is found at other sites in the pelvis. Bleeding occurs from these tissues at the time of menstruation causing pelvic pain and painful periods. Cysts may develop within the ovaries, causing pelvic scarring that affects the fallopian tubes and leads to infertility. Endometriosis occurs when tissues similar to the lining of the uterus grow outside of the uterus.
The cause of endometriosis is unknown. The diagnosis is frequently made because of the technical ease of modern videolaparoscopy. The glib explanation is that endometriosis follows retrograde menstruation, but much laboratory and clinical evidence suggests that endometriosis is more complex than this. We have recently suggested that endometriosis is a disease of angiogenesis since in endometriosis, the endometrium, as well as endometriotic plaques, seems to have greater angiogenic activity than does the endometrium of normal women.
Endometriosis can affect many organs surrounding the uterus, fallopian tubes and ovaries. This sometimes includes the bladder and bowels. Endometriosis can interfere with conception and be a factor in infertility.
Approximately 10% of infertile couples are affected by endometriosis. 30-40% of patients with endometriosis are infertile. This is two to three times the rate of infertility in the general population. For women with endometriosis, the monthly fecundity (chance of getting pregnant) diminishes by 12 to 36%. This condition is characterized by excessive growth of the lining of the uterus, called the endometrial. Growth occurs not only in the uterus but also elsewhere in the abdomen, such as in the fallopian tubes, ovaries and the pelvic peritoneum. A positive diagnosis can only be made by diagnostic laparoscopy, a test that allows the physician to view the uterus, fallopian tubes, and pelvic cavity directly. The symptoms often associated with endometriosis include heavy, painful and long menstrual periods, urinary urgency, rectal bleeding and premenstrual spotting. Sometimes, however, there are no symptoms at all, owing to the fact that there is no correlation between the extent of the disease and the severity of the symptoms. The long term cumulative pregnancy rates are normal in patients with minimal endometriosis and normal anatomy. Current studies demonstrate that pregnancy rates are not improved by treating minimal endometriosis.
Treatment of endometriosis is either medical (using drug therapy) or surgical (using laparoscopy or open surgery), depending on the extent of the disease. IVF is an appropriate treatment for endometriosis-induced infertility when other methods have failed.
