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Endometriosis

Endometriosis is a Common Cause of Infertility in Our Los Angeles Fertility Center.

Endometriosis is a disease where tissue that normally grows inside the uterus (endometrium) grows outside of the uterus.  In endometriosis, the endometrium attaches to other organs in the pelvis such as the ovaries and begins to grow.  We don’t know why some women develop endometriosis.  It is estimated that 10% of all reproductive women have endometriosis, but it may be found in up to 50% of women with infertility.

Many women who have endometriosis have no symptoms or very few symptoms.  Some women may have extremely painful menstrual cramps, chronic pelvic pain, or pain with intercourse.  Other women have no symptoms and only learn about their endometriosis during an infertility work up.

Studies have found a relationship between endometriosis and infertility, however not all women with endometriosis have infertility. It is estimated that normal couples have a 15-20% fertility rate but in women with endometriosis this fertility rate may only be 2-5%.

Endometriosis is not diagnosed only by symptoms.

Pelvic exam findings such as feeling nodules or an enlarged or stuck ovary can suggest the presence of endometriosis.  Ultrasound can allow identification of cysts on the ovary that are from endometriosis (endometriomas). However, while symptoms, pelvic exams, and ultrasound can strongly suggest the presence of endometriosis, the only way to confirm endometriosis is through surgery.

Unfortunately, there is no treatment that cures endometriosis.  However, there are multiple treatments for the management of endometriosis symptoms.  Unfortunately many of these treatments cannot be taken while actively trying to achieve pregnancy.  Treatment choices vary and will greatly depend upon symptoms from endometriosis, the predicted or known severity of the endometriosis, previous endometriosis treatments, and other infertility cofactors such as ovarian reserve, age, and duration of infertility.

Treatment options for infertility related to endometriosis may include surgery to remove scaring or areas of endometriosis including endometriomas, medications to increase ovulation (superovulation) such as clomiphene citrate or injections combined with intrauterine insemination (IUI), and IVF.   The largest study looking at surgery for treatment of infertility related to endometriosis showed that within 9 months of surgery 29% of women with minimal to mild endometriosis conceived who had surgical treatment compared to 17% of women who did not have surgical treatment of their endometriosis.  Multiple studies have shown combining superovulation with IUI increases pregnancy rates in patients with minimal or mild endometriosis.  IVF is often the most effective treatment for patients with endometriosis.  The success rates for each of these techniques will vary greatly by age and severity of endometriosis.