Endometriosis (pronounced en – doh – mee – tree – oh – sis) is the name given to the condition where cells like the ones in the lining of the uterus are found outside the uterus in the pelvis and occasionally in more remote sites of the body.
Every month a woman’s body goes through hormonal changes. Hormones are released from the ovary and cause the lining of the uterus to prepare for an embryo. If pregnancy does not occur this lining will break down and shed. This is then released from the body as a period.
Endometriosis cells react in a similar way except that they are located outside the uterus. During the monthly cycle, hormones stimulate the endometriosis, causing it to grow, then break down and bleed. This internal bleeding, unlike a period, has no way of leaving the body. This leads to inflammation, pain, and the formation of scar tissue (adhesions). Endometriosis can also be found in the ovary where it can form cysts. These cysts are often filled with old blood and have the appearance of chocolate when opened. Thus they are called ‘chocolate cysts’.
The inability to conceive can be one of the most devastating consequences of endometriosis. Not only does a woman have to deal with a debilitating disease and all the pain it brings, she may also have to deal with infertility.
It is fortunate that not all women who have endometriosis are infertile. It is estimated that around 30-40 per cent of women with endometriosis suffer from fertility problems.
Between 30 and 40 per cent of women undergoing laparoscopy as part of an infertility evaluation are found to have endometriosis.
There appears to be a number of mechanisms by which endometriosis impacts on fertility. Scarring or adhesions in the pelvis cause infertility. The scarring and adhesions that occur with endometriosis may mean that the ovaries and fallopian tubes are not in the right position and so the transfer of the egg to the fallopian tube cannot take place. Similarly, endometriosis can cause damage and/or blockage to the inside of the fallopian tube, impeding the journey of the egg down the fallopian tube to the uterus.
Another factor that could cause infertility for women with endometriosis may be the over-production of chemicals associated with inflammation such as prostaglandins.
These are hormones that play an important role in the fertilisation and implantation of the embryo. An excess of prostaglandins may interfere with these processes.
Because endometriosis often causes painful intercourse, couples may fail to try during the woman’s most fertile period.
Statistically women with endometriosis have fewer children than women who do not have the disease. After assessing the obstetric history of women with endometriosis, it was found they were much more likely to have had tubal pregnancies, premature labours and stillborn babies than women without endemetriosis.
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