Endometriosis

This is the presence of endometrial tissue outside (ectopic ) the uterine cavity.

This ectopic endometrail tissue responds to the hormonal changes in the body just like the normal endometrial tissue present within the uterine cavity.

The normal endometrial tissur present in the uterine cavity gets discharged from the body during periods. But this ectopic endometrial tissue has no outlet and it remains to irrotate the surrounding tissue.

Between 20-40% of infertile women have endometriosis.

Symptoms of endometriosis:

-    Pelvic pain

-    Pain during intercourse

-    Infertility

Mechanisms of infertility

-    Distorted anatomy

-    Negative effect on the follicle and egg development and fertilization

-    Negative effect on tubal function

-    Negative effect on the endometrial receptivity

Management

Pregnancy cannot occur during the medical therapy of endometriosis, and because the treatment has been shown not to be helpful in improving subsequent fertility, medical therapy for endometriosis is no longer advised for infertile women.

Chocolate cysts of the ovary are less likely to respond to medical therapy.

Surgery may be needed to improve fertility by removing adhesions, lesions, nodules or endometriomas.

Women with endometriosis are always advised to avoid delay in planning their family. If spontaneous conception doesnot occur, IUI or IVF is advisable depending on the duration of infertility and other associated factors.

Women with endometriosis often have a poor ovarian response and may require to proceed with donor egg IVF as last resort.