The unknown disease of reproductive-aged women.

Growing a family and becoming a mom is a lifelong dream – full of excitement.  When it is finally your turn to get pregnant, you do not dwell too much on the fact that something could go wrong.

The larger scientific and reproductive endocrinology community still has a lot to learn about endometriosis, but what we do know remains a large and complex maze. Women’s health issues and diseases often tend to go under the radar. However, it seems that endometriosis exists in about 1 in 10 women.

Endometriosis is a debilitating disease where cells of the endometrium (lining of uterus) are found outside the uterus, such as in the peritoneal cavity or attached to other organs like the ovaries, bowel, bladder or lungs. This is problematic because when these endometrial cells are found outside of where they are supposed to live (i.e. in the endometrium of the uterus), they go through the same changes during the menstrual cycle, thereby creating an inflammatory reaction which leads to an inflammatory response.

Evidence of this can be seen on laparoscopy as a brownish mixture, which is filled with blood and immune response cells like macrophages, other white blood cells, and cytokines (proteins).

This is an issue for two reasons:
1. It blankets the ovaries and affects egg quality, it can cause scarring in the tubes and impact sperm.
2. The inflammatory response can decrease the ability of an embryo to implant or grow in the endometrial lining (early loss or failed transfer cycles). Many women present with pain with menstruation as the primary symptom of endometriosis.

However, there are other symptoms that are key to identifying the disease:
• Pelvic pain outside of menstruation (often said to feel like a burning sensation)
• Pain or pressure during intercourse
• Pain with ovulation
• Cramping after an orgasm (dysorgasmia)
• Pain with bowel movement and urination
• Infertility and pregnancy loss
• Brain fog
• Chronic fatigue
• IBS
• Depression

Not all women with an endometriosis diagnosis struggle with infertility, but about 50% of infertile women are known to have endometriosis.

Fertility specialists face a great deal of complexity when treating infertility patients with endometriosis due to a lack of compelling and conclusive data.

When it comes to treatment options for women with endometriosis, in vitro fertilization (IVF) is often the best treatment option in terms of pregnancy success rates. The use of certain medications that prevent estrogen levels from reaching very high levels in both stimulation and transfer cycles works well for women with endometriosis because it may help with the inflammatory impact of endometriosis on both eggs and the endometrial lining.

Overall, endometriosis does impact fertility and for many patients we still do not know the primary mechanism of infertility with endometriosis. Is it an egg quality issue, or is it an issue with the potentially altered environment of the endometrial lining of the uterus?

One thing we do know is fertility specialists have hands-on experience working with women who are battling infertility and endometriosis. Are you 1 in 10?

Advancements in the understanding of how endometriosis impacts fertility is so needed. This is a recent study that investigates how endometriosis may impact egg quality. We found it an interesting read. Click here to read study.