Endometriosis Infertility

The endometrium is the inside lining of the uterus which is shed and regenerated with every menstrual cycle. When endometrial tissue is located outside of the uterus, the diagnosis of endometriosis is made. Such tissue may be pathologically located on various pelvic organs such as the uterus, tubes, and ovaries, as well as bowel and bladder. When present in the pelvis, endometrial tissue may lead to an inflammatory reaction which has been shown to affect the reproductive process at various levels from egg development and ovulation to fertilization, embryo travel through the fallopian tube, and uterine implantation. Furthermore, endometriosis may lead to scar tissue (adhesion) formation within the pelvic cavity, which in turn may lead to blockage of the fallopian tubes as well as debilitating pelvic pain.

The treatment of infertility associated with endometriosis often depends on the patient’s symptoms, and findings on hysterosalpingogram (HSG). Treatment may range from surgical fulguration (burning)/resection (usually by laparoscopy) of endometriotic implants to pituitary downregulation and superovulation with intrauterine insemination or in vitro fertilization (IVF). Occasionally, combination treatment with various modalities is employed to achieve pregnancy. Infertile women with endometriomas (endometrial implants within the ovary which have grown into cysts visualized by ultrasound, also known as “chocolate cysts” due to their chocolate-colored cyst content consistent with old blood) present a unique challenge as a careful evaluation for ovarian reserve and consideration of clinical findings such as endometrioma size and pelvic pain must be made before proceeding with surgical resection.

Endometriosis may present itself in multiple forms of varying severities, and treatment must be customized for each patient based on history, symptoms, and clinical findings. The California Center for Reproductive Health employs only safe and proven methods in establishing a clear diagnosis of endometriosis and administering appropriate treatments. Patient with endometriosis suffering from infertility are treated with specific stimulation protocols which have been validated to have superior success rates. Important ovarian reserve tests are performed to determine how aggressive fertility treatments should be (not every patient with endometriosis will need IVF). Every effort is made to avoid surgical resection of endometriomas in order to prevent deterioration of ovarian reserve and damage to healthy ovarian tissue.