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Endometriosis: Fact, Fiction, and Fertility

Fertility Partnership is a leading provider for treatment of endometriosis. We will get the correct diagnosis and then offer treatment based on Your planned outcome. Whether it be controlling the pain, or getting pregnant, Fertility Partnership will help.


Endometriosis is a condition that affects anywhere from 3% to 7% of the general female population. It also represents 30% or more of all of the couples coming to my office seeking help for infertility. Endometriosis occurs more often than one thinks, and the diagnosis is often delayed until a woman is in her twenties or even thirties. By then, much damage may have occurred. I believe that if we were more aggressive in diagnosing this disease earlier we would be able to prevent unnecessary pain and many of the cases that I see in my fertility clinic.

Fact: Endometriosis is a condition where cells that normally reside in the lining of the uterus and respond to monthly hormonal signals are found outside of the uterus. Islands of endometrial lining take root on the ovaries, fallopian tubes, and other pelvic organs. This means that when a woman is menstruating and there is flow out onto a tampon or pad she is also menstruating internally, shedding cells and blood into her pelvis. Basically, it is if she is gut-shot monthly.

Fiction: All women with endometriosis suffer from severe pain. While 80% or so of patients will report severe, monthly pelvic and abdominal pain and other symptoms, many women are symptom-free. In fact, the very worst case of endometriosis I ever saw was diagnosed when I saw tell-tale signs when I performed a pelvic ultrasound. Her only symptom that led to her diagnosis was that she was struggling to get pregnant.

Fiction: All women with endometriosis are infertile. This is not true but endometriosis can often cause infertility. As I stated above, endometriosis is present in at least 30% of the women in my clinic. The way it causes infertility is very simple in severe cases. The monthly internal bleeding produces scarring in the pelvis leading to fallopian tubes, uterus, and ovaries being stuck together and often to the bowel. This is what I would call a “plumbing problem”, the sperm and the eggs can simply not meet. But even mild cases where there is no scarring, fertility rates are lower. The cause of this is not completely understood but the generally excepted idea is that the repetitive monthly internal bleeding leads to a pool of brownish fluid that is settled in the pelvis. Because the diagnosis is made at the time we actually operate and look inside, we typically see this puddle of brown fluid. The theory is that as the egg leaves the ovary and enters the tube, this brief exposure “hardens the egg”. That is to say, the inflammatory by-products from the old blood render the egg impenetrable to the sperm. It cannot get into the egg and fertilize it. Fortunately, the impact of mild endometriosis on the woman’s chances of getting pregnant is much smaller than the worst forms that cause scarring.

Fact and Fiction: Getting pregnant will cure a woman of her endometriosis. This is sometimes true but most women will see a recurrence of their endometriosis within two years of giving birth. Pregnancy is helpful because a woman does not menstruate while she is pregnant and usually not while she is breastfeeding. This period of no bleeding allows the body to shrink the endometriosis lesions down and sometimes makes it go away forever. Actually, endometriosis can be treated with medicines and the strategy of each of the medications is to mimic pregnancy by stopping a woman from having her menstrual period. Unfortunately, like pregnancy, the endometriosis usually bounces back when the therapy is over.  The only way to completely eradicate endometriosis is for a woman to reach natural menopause or for her to undergo “surgical menopause” by having her ovaries removed. That certainly isn’t a good idea for a woman trying to have a baby but effective for a woman whose main concern is to stop the pain.

Fact: The ONLY way to definitively diagnose endometriosis and to determine how extensive it is, is to undergo a surgical procedure known as laparoscopy. A small hole is made in the umbilicus, otherwise known as the belly button, and a thin fiber optic scope is paced in the belly and the organs inspected. The surgeon can often treat the endometriosis and make significant improvements in a woman’s symptoms and her fertility.

Unfortunately, many young women and teenagers suffer from severe menstrual cramps, missing school or work and are not diagnosed. Years go by and the damage is done. It is my opinion that doctors should be far more willing to recommend laparoscopy so that the condition can be diagnosed sooner. I truly believe that if we could find identify endometriosis earlier in a woman’s life and provide more aggressive management; this would lead to fewer future patients walking in the door of my fertility clinic.

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