Endometriosis and Conception
If you have been told you have endometriosis, the disease may seem strange. Endometrial tissue – the kind of tissue that lines the uterus – is found in places besides where it is expected to be. Sometimes the endometrial tissue is close to where it belongs, inside the muscle layers of the uterus. Sometimes the endometrial tissue winds up outside the uterus entirely and inside the abdomen. It can also be in or near the ovaries or intestines. On rare occasions it can be found as far away as the belly button and scars from surgery.
There are many ideas about how this tissue can get outside of the uterus. It could be that during some menstrual periods the lining flows backwards out the Fallopian tubes into the abdomen. The endometrial cells may get into the bloodstream and taken to other places, or there may be some completely different mechanism.
The endometrium responds to progesterone and other hormones telling it to prepare for pregnancy during the second half of the menstrual cycle. When pregnancy does not occur, chemicals called prostaglandins are released from the tissue and cause pain. The same thing happens to endometrial tissue outside the uterus. Women who have painful periods can feel pain in other places at the same time as their menstrual pain. If the tissue has gotten into the walls of the large intestine or bladder, blood may be seen from the rectum or in the urine.
The cause of this pain may be difficult to figure out initially. Endometriosis can be seen with an ultrasound examination as well as some other imaging studies. Laparoscopy must be done to get a definite diagnosis and idea of how widespread the endometriosis is. During laparoscopy, a doctor uses a tiny incision and a small fiberoptic light to see inside the abdomen.
Endometriosis is usually treated with medicine such as birth control pills and other hormones which can block the release of the chemicals that cause pain. This medical treatment is the best way to treat this condition unless pregnancy is being considered.
Endometriosis can cause infertility, although it is not known exactly why this happens. Endometrial tissue (called endometriomas) may physically interfere with the movement of an egg from the ovary into the Fallopian tube. Or there may be a more complicated reason.
Via laparoscopy, doctors can use a tool with a hot tip to destroy small visible endometriomas. The goal is to remove any tissue that might be interfering with fertility without causing damage. Doctors may also cut out small areas or use a laser to eliminate them. This type of surgery can be successful in allowing a woman to become pregnant.
If a woman whose endometriosis has been treated with surgery still does not become pregnant, other treatments should be considered. Sometimes stimulating the ovaries with clomiphene citrate along with artificial insemination (IUI) will result in pregnancy.
In other cases, in vitro fertilization may be the best way to achieve pregnancy. The choice of how to proceed depends on the age of the woman and the amount of endometriosis.