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Endometriosis is thought to affect approximately between 1 and 15% of women. Of the women affected, many go undiagnosed as there are no symptoms present. Of the women unfortunate enough to suffer badly from the disease, most experience fertility related problems. This may be secondary infertility, in that they may have already had a child and experienced difficulty at a second conception, at which time the condition is diagnosed.

The endometrium is otherwise known as the lining of the womb and the disease manifests itself as the same cells are established outside the womb e.g. on the ligament supporting the uterus. in the ovaries, tubes, pelvis, bowels, bladder, etc. In patients with endometriosis, these cells, like the endometrium, respond to the monthly hormonal changes. When a woman with endometriosis menstruates, the endometrium is shed in the form of a period, the endometriosis breaks down in the same way but because these cells are trapped inside, and cannot escape, they form swellings filled with dark blood (known as chocolate cysts) and adhesions which may damage the tubes.

The condition usually affects women in their 30’s and 40’s but it is also prevalent in younger women also. An explanation for the higher record of cases in older women may be purely a result of common use of the contraceptive pill, in which cases of endometriosis may go undiagnosed as the condition is masked by the affects of the drug.

Some patients with endometriosis may have no symptoms; some may experience considerable pain during their periods or during intercourse and many experience problems with conception.

On vaginal examination their may be tenderness and thickening of the supporting ligaments of the uterus in women with endometriosis. Ovarian cysts may also be felt by the doctor.

The majority of women with endometriosis are fertile. However, some women may experience difficulty becoming pregnant. Medical treatment is often the first option and is often successful. If not, surgical treatment, in the form of laser laparoscopy may be considered and has a good success rate where fertility is considered. In 20% of women, the endometriosis is recurrent, which means that even after treatment, both medical and surgical, the disease will return. In cases such as this, a continuous check-up on the condition is recommended by an experienced gynaecologist. If a pregnancy is not successful naturally, then assisted conception should be considered sooner rather than later.

How does endometriosis cause infertility?
The anatomical distortion caused by endometriosis, especially when it is moderate and severe, could explain a mechanical cause of infertility, the precise mechanism by which minimal and mild endometriosis affect fertility is not fully understood. It is possible that endometriosis adversely affect the egg development, sperm binding to the egg, fertilization, tubal function and embryo implantation.

Diagnosis
The only means of diagnosis of endometriosis is by laparoscopy, which assesses the severity of endometriosis and the condition of the Fallopian tubes. There are a number of different classification systems for endometriosis, but the most widely used is that of the American Society for Reproductive medicine (ASRM) in which endometriosis is classified into four stages: minimal, mild, moderate and severe. There is little correlation between the severity of symptoms and extent of the endometriosis.

Ultrasound scans, CAT scans, or MRI scans, can identify cysts on the ovaries. However, these techniques can not be used to make a definitive diagnosis of endometriosis.

How does it occur?
The actual cause of endometriosis is unknown. However, the most widely accepted explanation for endometriosis is that viable cells from the lining of the womb pass upwards into the Fallopian tube and out into the pelvic cavity where they settle down. In most women these cells will be destroyed by the woman’s immune system. However, in some women, these cells implant and proliferate, possibly due to a disorder of the womans’ immune system. There are currently several studies being carried out on the genetic relationship of endometriosis. In some families there may be no other diagnosis of endometriosis but often other menstrual related problems exist. In many of these examples, fertility is not a clinical problem, which suggests that it is in fact the endometriosis that causes the subfertility, although many argue that endometriosis is secondary to infertility. This is an area which requires a vast amount of research, particularly in family studies, as this may enable scientist to consider the hunt for a specific gene which may be malfunctioning.

If you suffer from fertility related problems and other member of your family have experienced some form of menstrual related problem and you would like to take part in a study, please send your details to research@assistedconception.org.