The female reproductive system consists mainly of the ovaries, the uterus, the fallopian tube and the vagina. The uterus is also where a problem like endometriosis occurs. It is also known to usually occur in women in the reproductive age group.

The uterus has a tissue lining that prepares itself every month to receive the sperm for fertilization. When fertilization does not take place the lining is shed, the event being the menstrual cycle. When this tissue lining that normally covers the inside of the uterus starts growing outside the uterus. It also grows on other organs like the fallopian tubes, even the uterus or the ovaries. Endometriosis has three grades namely, Mild, Moderate and Severe

Here are some symptoms that may indicate you have endometriosis

  • Pelvic pain.
  • Infertility.
  • The areas of endometriosis bleed each month resulting in inflammation and scarring.
  • Diarrhea or constipation.

Diagnosis of endometriosis is done via Ultrasound and Laparoscopic imaging (gold standard)

Management of endometriosis

  • Treatment of pain by pain killers and NSAIDS.
  • Surgical correction (of chocolate cysts and excision of endometriotic spots).
  • Medical management.
  • Combined oral contraceptive therapy.
  • Progesterone therapy *gnrh agonists.
  • Treatment for infertility by IVF.
  • Newer Drugs – Cabergolin, Dinogest.

Management of infertility in endometriosis patients is also done in response to the grading of the diagnosis –
Grade Mild would involve OI + IUI * 6 cycles. IVF if no conception by IUI.
Grade Moderate will involve OI + IUI * 2-3 cycles. If the tubes are not affected, then jump to IVF in case of no conception after IUI.
Grade Severe requires surgical correction followed by IVF- if there is presence of large endometriosis. This would also include medical treatment by gonadotropin releasing hormone agonists for 2-3 cycles followed by IVF with donor egg if ovaries are severely affected.
How Does Endometriosis Specifically Lead to Infertility.

  • Adhesions among ovaries, uterus and fallopian tubes impede the transfer of the egg to the fallopian tube.
  • Ovarian implants prevent release of the egg.
  • There is a decrease in the number and quality of eggs.
  • The distortion of pelvic anatomy by disease adhesions disturbs the tubo ovarian relation or damages the tubes and so leads to infertility.

It is important to note that endometriosis patients should resort to ART soon as this disease is bound to increase with time.

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