Dr Kshitiz Murdia
Endometriosis is a disease affecting women of reproductive age; it may be associated with both pelvic pain and infertility. So while this simple definition of the disease is helpful for people looking for a straight definition, truth is that much remains unknown about the disease.
The advancement in science has improved our understanding of this disease and offered better prospects for treatment. But the confusion persists, especially among women who can’t decide if they are experiencing infertility because they might have endometriosis, or because they have endometriosis and hence are not able to conceive.
However, before we can help you fight the confusion; let us first have an in-depth discussion on the disease.
Endometriosis is a disease which involves the growth of tissue resembling the endometrium (uterine lining) in areas outside the uterus. It may lead to formation of cysts known as endometriomas or ‘chocolate cysts’ in the ovaries. There is also a possibility of the growth of implants of endometriosis on the peritoneum (the lining of the abdomen and pelvis), which might at times cause scarring which may as well involve the ovaries and block the tubes.
In some cases, endometriosis grows deep beneath the peritoneal lining, in the area between the vagina and the rectum. In such circumstances there is often more severe pain. But you can’t always associate it with severe infertility problems.
While suspicion of the disease can arise on the basis of signs, symptoms and physical examination, the sure-shot way to determine the presence of this disease is through laparoscopy.
The cause of the disease however remains largely unknown. While several immunological and biochemical changes are often associated with the occurrence of this disease, but a theory hasn’t yet been designed that can fully justify the cause behind it.
A lot of women that suffer from this disease have painful periods, deep pain during penetrative sex, chronic pelvic pain, painful bowel motions or urination during menstruation. There also could be no symptoms at all other than having difficulty getting pregnant. There are also some that have absolutely no symptoms at all.
Reports on the disease suggest that 30% to 50% of infertile women have endometriosis. One question that almost every woman who has been facing trouble in conceiving would want to ask is, does endometriosis cause infertility?
The answer is, if you have endometriosis, you may face greater trouble when trying to get pregnant. And around 30% to 50% of women suffering from endometriosis may experience infertility. The disease can influence fertility in several ways; like distorted anatomy of pelvis, changed immune system functioning, scarred fallopian tubes, adhesions, impaired implantation of a pregnancy, altered egg quality, inflammation of the pelvic structures and changes in the hormonal environment of the eggs. However with options available like IVF for treatment of moderate to severe endometriosis, there is actually no reason to fret.
While undergoing surgery for the disease there is an evaluation of the depth, amount and the location of the endometriosis. This result helps the doctor determine the stage of endometriosis. This ‘result’ finds if endometriosis is in the minimal, mild, moderate or severe stage.
This study later helps determine the prospects of pregnancy. Women that suffer from severe endometriosis often face difficulty in conceiving and many a times often have to undergo advanced fertility treatment like IVF. The stage-4-endometriosis (severe endometriosis) results in extensive scarring, blocked fallopian tubes, and damaged ovaries.
Female hormone estrogen is required by endometriosis to grow and develop. When it comes to relieving the pain, birth control pills and other drugs that can lower estrogen are seen to be effective.
Also, women wanting to get pregnant can go for medical therapy prior to attempts at conception. During IVF for treatment of moderate to severe endometriosis if the doctor sees endometriosis, he can surgically remove the scarred tissue or destroy it. This can help increase chances of your getting pregnant. The treatment also helps restore your normal anatomy.
While the effectiveness of this treatment is highly individualized, but women that are at the moderate or severe stage of endometriosis can have enhanced chances of conceiving post the surgical treatment of advanced reproductive techniques like IVF, because the treatment enables your reproductive organs to function normally.
Furthermore, experts say that a combination of surgical treatment, medical therapy and advanced reproductive techniques like IVF can work wonders for women.
(The author is Infertility & IVF specialist at Indira Infertility Clinic & Test Tube Baby Centre, New Delhi)
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