Dr. Dan Martin
Scientific & Medical Director, Endometriosis Foundation of America
Endometriosis, which affects one in 10 women in the United States, is a complex disease with many faces. One of those faces is infertility.
Endometriosis can inflict unbearable physical and psychological pain, and typically with little sympathy or understanding from the general public. The disease occurs when tissue, like the endometrium (the interior lining of the uterus), is found outside of the uterus. Because of a lack of awareness and the normalization of pelvic pain in women, it can take six to 10 years or longer to get diagnosed. By then, someone who has been trying to get pregnant may have suffered through years of pain and infertility.
Endometriosis may cause infertility in a few ways. One is that it creates an inflammatory environment throughout the reproductive system and other organs as it grows and spreads. Another is that chocolate cysts — cysts filled with old blood — push inside the ovaries and cause them to malfunction. A third is that adhesions and scar tissue caused by the disease block the pathway as eggs try to travel to the fallopian tubes.
While we have come a long way in learning about endometriosis, we took a step back in recent years in tying it to infertility. In the 1950s and 1960s, before we had laparoscopic surgery, a lot of infertility was unexplained. When laparoscopies were performed in the late 1970s and early 1980s to explore infertility, doctors often found and treated endometriosis in the absence of pain. As the success rate of in-vitro fertilization (IVF) increased in the late 1990s, doctors bypassed laparoscopies and went straight to IVF when there was no pain. Today, women with no pain may have endometriosis-associated immunological problems that contribute to “unexplained” infertility without a surgical diagnosis. However, surgical diagnosis and treatment may not be needed as these women may respond to medical suppression.
Most infertility doctors are aware of endometriosis and its connection to infertility. If your doctor does not discuss endometriosis with you or doesn’t know anything about it, ask them to refer you to a doctor who does. If they don’t know anyone, do your homework by contacting hospitals, endometriosis specialists, or national organizations such as EndoFound.
Almost 2,000 peer-reviewed papers about endometriosis are published yearly; we are making significant strides with this disease. And it’s this knowledge about the connection it has to infertility that can help explain the unexplainable and put future parents on a path toward healing and pregnancy.