Written by Shahin Ghadir, MD (Southern California Reproductive Center)
The lining of the uterus is known as the endometrium. Endometriosis is a gynecologic condition in which bits of tissue similar to endometrium are found in areas of the body outside the uterus. Endometriosis lesions can appear anywhere in the pelvic cavity: on the ovaries, the fallopian tubes, the pelvic sidewall and the uterosacral ligaments. They can also appear outside the pelvic cavity - in the intestines, appendix, rectum, and even such far-flung places as the nose, although this is not common.
These lesions, termed "endometriosis implants," respond to female hormones like estrogen and progesterone, just like the endometrial lining does. They can even bleed in microscopic amounts just like a menstrual period. This bleeding leads to local irritation and inflammation in the sites of implantation. The inflammation causes scar tissue to form, causing pelvic pain and impeding normal functioning of pelvic organs.
The cause of endometriosis remains unknown, although a cornucopia of theories, ranging from bacterial infection to genetic abnormalities, has been proposed to explain this baffling disease. One theory suggests that endometrial cells, which are present in the menstrual flow, can back up into the fallopian tubes, implanting there and in the ovaries, then spreading through various routes, such as the lymphatic system, to implant in other parts of the body.
You need to be properly evaluated so you can get an accurate endometriosis diagnosis.
Call SCRC right away at (800) 600-9112 to speak to one of our caring fertility consultants, or click here to contact us. We will schedule a consultation for you with an SCRC fertility specialist at one of our offices in the greater Los Angeles area who can help you.
There is a strong association between endometriosis and infertility, but a true cause-and-effect relationship has not been firmly established. However, we know infertility can result if:
In women with untreated endometriosis who are trying to conceive, the monthly fecundity rate (chance of pregnancy each month) is 2-10%, compared to 15-20% in the general population. Some studies have suggested that 30%-50% of women with endometriosis experience infertility.
All of the symptoms described above may point towards an endometriosis diagnosis, but are not sufficient to establish a diagnosis. A pelvic exam can sometimes allow your gynecologist to identify endometriosis lesions by palpation (feel), but again, this is not reliable enough for a conclusive diagnosis of endometriosis. The only true way to diagnose the condition is through a minimally invasive exploratory surgery of the abdominal cavity called laparoscopy. Laparoscopy employs a lighted, fiber-optic tube (called a laparoscope) containing a camera and surgical instruments, which is introduced through a minimal incision in the abdomen. This gives the surgeon an excellent view of the pelvic and abdominal region. In this way, any endometriosis lesions can be easily identified and the endometriosis diagnosis confirmed.
In terms of treatment, it is important to clarify your goals. Some patients do not wish to conceive and just want relief from their pain.
For pain relief only (not infertility treatment):
The most popular type of endometriosis surgery today involves using laparoscopy to remove endometriosis lesions from the pelvic region. The lesions are often "burned off" by a procedure called laser ablation. The laser apparatus is just one of the instruments passed through the laparoscope. The laser ablation referred to here should not be confused with the term "endometrial ablation." Endometrial ablation refers not to ablation of endometriosis lesions, but rather to ablation of the endometrium (the actual lining of the uterus) itself. In addition to the destruction of pelvic endometriosis lesions, surgical removal of cysts and adhesions on the ovaries is also accomplished using laparoscopy. This type of endometriosis surgery offers better pain management over extended periods of time than drug treatment, but repeat surgery may be required in the future.
The endometriosis treatment that offers the best hope for a cure is a total hysterectomy - this is the removal of the uterus, both ovaries, and the fallopian tubes. This is a drastic treatment option, and should not be undertaken lightly, as pregnancy is no longer possible. Also, a cure cannot be completely guaranteed; rarely, endometriosis may return after hysterectomy.
For patients with endometriosis who wish to conceive, we will implement an aggressive treatment plan. Often patients with endometriosis need advanced treatments such as GnRH agonists (Lupron/Lupron Depot), and frequently, IVF (in vitro fertilization). In our experience as fertility specialists, we find that endometriosis presents a much greater infertility problem than the severity of the symptoms might suggest. Our patients with endometriosis who want to conceive tend to perform very well during the process of IVF; in fact, they do as well as patients that do not have endometriosis when undergoing IVF.
If you have been previously diagnosed with endometriosis, or suspect that you have it (based on painful periods, pelvic pain or pain with sexual intercourse), you should call SCRC at (800) 600-9112, or click here to contact us and schedule a consultation for you with an SCRC fertility specialist. During your initial consultation, we will review endometriosis in depth with you and look for clinical clues to pinpoint your diagnosis.
After a comprehensive evaluation, our physicians will individualize a treatment plan for you. It may include surgical exploration of your reproductive organs using laparoscopy, or we may recommend proceeding directly with fertility treatments. We prefer to reserve surgical management for our younger patient population. We find that older patients tend to do much better by proceeding directly to IVF.
The fertility specialists at SCRC are experts in endometriosis treatment. Los Angeles area women have trusted us for nearly 30 years because of our specialized training, patience, and skill in dealing with this complex disease. Let us help you improve your quality of life while helping you conceive and build your family