CAN ENDOMETRIOSIS CAUSE INFERTILITY?
Infertility has long been felt to be associated with endometriosis, but the reason endometriosis might cause difficulty getting pregnant has not been established. In fact, it may be that the cause of the endometriosis may also independently cause infertility. We know that about 5% of women who have had children and request tubal sterilization will be noted to have areas of old endometriosis at the time of their surgery. Therefore, the presence of endometriosis does not, per se, imply that a woman can not get pregnant.
However, it does appear that the chance of getting pregnant is decreased somewhat if you have endometriosis, and the more endometriosis you have, the less likely you are to get pregnant. Endometriosis appears to start as small areas of abnormally situated endometrial lining cells. As the tissue grows and bleeds, scar tissue forms around it, increasing the amount of damaged tissue. The scar tissue may even grow around the tubes and ovaries in a way that blocks the passage of the egg down the tube.
The probability of a healthy woman getting pregnant is about 25% per month. For women with mild endometriosis, where the endometriosis is present in small amounts and has not caused any scarring, the pregnancy rate is about 7% per month. For women who have severe endometriosis, where extensive scarring, blockage of the fallopian tubes, and large cysts in the ovaries are present, it is not hard to understand why pregnancy rates are extremely low without treatment.
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Not every case of endometriosis results in fertility problems, but in general, women with the disease are more likely to have trouble conceiving. The connection between endometriosis and infertility is related primarily to structural issues, that is, resulting distortions such as tubal blockage and adhesions. Endometriosis may also play a role in fertility problems by creating an environment in the local abdominal cavity that is hostile to egg fertilization and embryo development.
"Several investigators have also suggested that patients with endometriosis may be missing key proteins within the uterine wall that may impair embryo implantation," says Surrey who recently conducted a one-day course for reproductive experts attending the annual meeting of the American Society for Reproductive Medicine.
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Treatment options if you're trying to get pregnant:
If you have minimal or mild endometriosis, you'll have a 30 to 60 percent chance of getting pregnant within two years of completing therapy. If you have a moderate case, you'll have a 60 percent chance, and if you have a severe case, you'll have a 35 percent chance.
One option is to have your doctor remove your abnormal growths and tissue with a laser or surgical tool during your laparoscopy, a relatively simple procedure. Afterward, you'll have a 40 percent chance of conceiving. Your chances will be highest within a year of the treatment, since endometriosis commonly recurs in spite of the operation. If you have a mild case of endometriosis and are trying to get pregnant, your doctor may suggest that you forgo treatment for six to 12 months. If you don't conceive during that time, you might consider your treatment options.
You may also start additional therapy for other problems discovered during your fertility workup. Certain additional therapeutic options include taking fertility drugs in conjunction with artificial insemination or in vitro fertilization.
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