What is Endometriosis?

Endometriosis is a common gynecologic disorder associated with pelvic pain and infertility. It affects as many as 1 in 10 women of reproductive age and up to 30-50 percent of women with infertility.

Endometriosis occurs when the endometrium, the tissue that normally lines the uterine cavity, develops or implants outside of the uterus.

Endometriosis is thought to form most frequently from retrograde menstruation, or the backward flow of menstrual blood and tissue through the fallopian tubes into the pelvis. Normally this tissue will be cleared by the body’s lymphatic system and immune cells. However, endometriotic cells escape these normal clearing mechanisms and instead, may attach to and invade other structures.

Endometriosis is commonly found on the internal surface of the abdominal cavity (peritoneum) and pelvic organs, such as the ovaries, uterus, fallopian tubes, bladder, and intestines. Some implants are superficial, whereas others can be deeply infiltrating.

Endometriosis responds to the hormonal signals throughout a woman’s menstrual cycle, and may grow and shed similarly to the normal uterine lining, causing internal bleeding, pain, inflammation, and sometimes scar tissue formation wherever lesions exist.

Endometriosis Surgery

Surgery remains the gold standard in the diagnosis of endometriosis and can also be used to treat pain symptoms and improve natural fertility.

Women with suspected or laparoscopically-confirmed endometriosis who are not seeking pregnancy should always use menstrual suppression after surgery to prevent the progression or recurrence of endometriosis and to reduce pain symptoms.

Progestin-only oral agents (e.g. norethindrone acetate), levonorgestrel-secreting IUDs, and the GnRH receptor analogues (e.g. leuprolide) are the preferred hormonal suppressants for women with endometriosis because they generally counteract or inhibit estrogen-stimulated growth and activity in both normal endometrial tissue and in endometriosis. Women, therefore, will have fewer bleeding days and fewer days of pelvic pain associated with their disease when treated with these hormonal therapies.

Endometriosis and Infertility: What Our Arizona Patients Need to Know

Endometriosis is often linked to infertility, but the exact reasons remain unclear. Experts believe it could stem from inflammation-related damage to the fallopian tubes or poor embryo implantation due to inflammatory responses in the uterus. While some women with endometriosis can conceive naturally, many struggle and require fertility treatments. Research suggests that women with endometriosis may experience lower pregnancy rates per treatment cycle compared to those without the condition, making early intervention crucial.

How Endometriosis is Treated

Several treatment options are available for managing endometriosis-related pain and improving fertility.

• Hormone therapy, such as oral contraceptives or progesterone, as it can influence hormone levels that impact the disease
• Pain medication like nonsteroidal anti-inflammatory drugs (NSAIDs)
• Surgical procedures to remove lesions or, in cases of severe disease, ovaries and fallopian tubes
• In vitro fertilization (IVF) to assist in pregnancy

CCRM Fertility of Arizona is at the forefront of research, and our physicians are leading investigations into new oral treatments that may not only reduce symptoms but also enhance fertility. As these advancements become available, they offer new hope for women seeking relief from endometriosis while pursuing their dreams of parenthood.

Why IVF Might Be the Best Option for Women with Endometriosis

IVF helps bypass some of the challenges associated with endometriosis, such as blocked fallopian tubes or painful intercourse due to adhesions or cysts. In IVF, eggs are fertilized in a lab setting, creating an optimal environment for embryo development. These embryos are then transferred to the uterus, where they have a better chance of implanting and leading to a healthy pregnancy.

Although some studies show that women with endometriosis may produce fewer eggs or experience lower implantation rates than women without the condition, the overall pregnancy success per IVF cycle remains significantly higher than in natural cycles. At CCRM Fertility of Arizona, we’ve pioneered protocols that improve IVF outcomes for endometriosis patients by using specific medications before preparing for frozen embryo transfers, increasing the likelihood of success.