Endometriosis is a disease characterised by:
Presence of functioning endometrial tissue outside the uterine cavity in so-called ‘ectopic sites’ such as on the ovaries, fallopian tubes, vagina, cervix, uterine and ovarian ligaments or in the Pouch of Douglas. Other sites may include bowel, ureters or bladder.
Inflammation of tissues as a reaction to the growth of the endometrium at these ectopic sites.
Endometriosis is a significant cause of infertility, because the woman partner is diagnosed with mild endometriosis in 10% of couples that have difficulty conceiving.
Why do women who have endometriosis have more difficulty conceiving?
Women who have endometriosis have more difficulty conceiving for a number of reasons, including:
The endometrium may be less responsive for implantation. Inflammation within the uterus, induced by the more vascular endometrium, may cause slight bleeding or “spotting” that becomes evident several days before the period is due. The blood within the endometrial cavity oxidises (rusts!), releasing chemicals that inhibit the development of the hatching embryo at the very time that the endometrium needs to have optimum function for implantation.
Sexual intercourse may occur less frequently because of pain from inflamed growths on pelvic ligaments.
Fallopian tubes or ovaries may be scarred as a result of inflammation. This can interfere with the ability of the follicle to release the ripe egg into the end of the tube.
Inflamed pelvic tissues may digest sperm. This may result in insufficient numbers of sperm to digest the cloud of cells around the ripe egg and for one sperm to fertilise the egg.
It may be physically impossible for the tube to pick up the egg because of a large cyst within the ovary. These cysts can develop from ectopic endometrium on the surface of the ovary, which can engulf deeper ovarian tissue, forming a small cyst lined with endometrium. This endometrium can then bleed regularly into itself, developing into a large endometriotic cyst.
Ovarian follicles may not develop, rupture and release the eggs well because inflammation in and around the ovaries may interfere with this important function.
What fertility treatment can assist women who have endometriosis?
Lipiodol (poppy seed oil) endometrial bathing / tubal flushing
Intra-uterine insemination with mild hyperstimulation using fertility drugs
Laparoscopic surgical removal of endometriosis has been shown to improve fertility, as well as helping to resolve pain symptoms.
Alternative treatments – such as herbs – may have an effect, although this is not scientifically proven.