Endometriosis :One of the Major Causes of Infertility in Female

What is endometriosis and adenomyosis?

Endometriosis is a common condition which is defined as endometrial tissue lying outside the endometrial cavity. It is usually found within the peritoneal cavity, predominantly within the pelvis, commonly on the uterosacral ligaments. It can also be found in other sites such as umbilicus, abdominal scars, nasal passages and pleural cavity.
Endometrial tissue responds to cyclical hormonal changes and therefore undergoes cyclical bleeding and local inflammatory reaction. Repeated bleeding and healing leads to fibrosis. This cyclical damage causes associated organs to ‘stick together’ causing pain and infertility.
Adenomyosis is when there is endometrial tissue found within the muscles of the uterus. This makes the uterus bigger and ‘boggy’ to feel. It causes heavy painful menstruation.
Endometriosis occurs in approximately 1-2% of women of reproductive age. It is the most common benign gynaecological condition, estimated to be present in between 10 & 15% of women. It is a condition that is estrogen dependent and therefore it resolves after the menopause or when treatment is directed towards inducing pseudomenopause.

The cause of endometriosis is unknown,although several theories have been used to explain the cause of endometriosis. 
Classical presentation are severe cyclical non colicky pelvic pain restricted to around the time of menstruation, sometimes associated with heavy menstrual loss. Symptoms may begin a few days before menses starts until end of menses. Other symptoms include pain on micturition (dysuria), pain on sexual intercourse (dyspareunia) and pain on defecation (dyschezia). Endometriosis in distant sites can cause symptoms, for example cyclical epistaxis with nasal passage deposits, cyclical rectal bleeding with bowel deposits.

It is estimated that 30-40% of patients with endometriosis complain of difficulty in conceiving. In many patients, there is a multifactorial pathogenesis to this subfertility. In the more severe stages of endometriosis, there is common anatomical distortion, with peri-adnexal adhesions and destruction of ovarian tissue when endometriomas develop.
From the balance of available evidence, medical treatment of endometriosis does not improve fertility and should not be given to patients wishing to conceive. However, surgical ablation/excision of minimal and mild endometriosis does improve fertility chances and surgical treatment of endometriomas probably increases spontaneous pregnancy rates including IVF success rates.



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