Infertility

Introduction
Definition
Incidence
Cause
Symptoms
Intestinal Endometriosis
Infertility
Diagnosis
Treatment
Adenomyosis
Are you too young to have
a laparoscopy?
Endometriosis and cancer
Treatment summary
Endometriosis and heredity

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For many years it has been recognized that Endometriosis is a major factor in infertility. There is no doubt that there is a strong association between Endometriosis and infertility. That is not to say there is a direct cause and effect, especially with the earlier stages of the disease. At one time, it was believed that Endometriosis caused infertility. However, it is now becoming increasingly apparent that there are basic physiologic abnormalities in women that not only make them infertile but also then predispose them to develop Endometriosis. In some women, the Endometriosis progresses to the point where it becomes their major problem whereas in other women, Endometriosis remains minimal and thereby serves as a clue as to what other factors may be present.

Everyone is aware of the fact that many women with Endometriosis are less likely to conceive. The term "fecundity" refers to a woman's ability to become pregnant. In normal, fertile couples, the monthly fecundity rate is 20-25%. Turned around, it means a normal woman will be pregnant in 4-6 months of active trying.

Spontaneous (untreated) monthly fecundity rates in women with Endometriosis are on 4-6%! Some studies have reported even lower rates. This means that without therapy, it will take a woman with Endometriosis (even early stage disease) at least 5 times as long to achieve a pregnancy.

Treating early stage Endometriosis itself, either with surgery or medical regimens only increases the monthly fecundity rate to somewhere between 5-7%. However, (and this is in keeping with the well documented high frequency of ovulatory abnormalities seen in women with Endometriosis), adding a regimen of ovulatory stimulation with drugs such as Clomid, Pergonal, Gonal-F, or similar drugs in combination with Intra-Uterine Insemination will increase the monthly fecundity rate to somewhere between 10-15t%.

What many people also do not recognize is that Endometriosis profoundly affects a woman's overall fertility - not just her ability to become pregnant but also her ability to remain pregnant. Women with Endometriosis have far worse obstetrical histories than women who do not have Endometriosis.

Although the data has been challenged, several studies have indicated that women with untreated Endometriosis have a spontaneous abortion rate of approximately 40-50% contrasted to the 10-15% abortion rate in the general population. Treating the Endometriosis reduces the abortion rate to "normal". Interestingly, women with the earlier stages of Endometriosis seem to have a higher abortion rate than women with more advanced Endometriosis, perhaps because their disease may be diagnosed later.

Women with Endometriosis statistically have fewer children than women who do not have Endometriosis. When looking at the obstetrical history of women before their Endometriosis is definitively diagnosed, within the 5 years prior to the diagnosis of their Endometriosis, these women are much more likely to have had not only a spontaneous abortion (one or more) but also tubal pregnancies, premature labors and stillborns. Why Endometriosis should affect a woman's reproductive capabilities in this fashion is unknown at this time. Abnormalities in the immune system may be the answer but the data is still preliminary. It is for this reason that it is necessary to establish a diagnosis of Endometriosis in women with the appropriate symptoms even though they have been pregnant before. This is a fact that many people do not understand.

Endometriosis is very commonly associated (?cause) with "one child infertility". Many women who had absolutely no trouble conceiving the first time and then who find it impossible to have a second child are found to have Endometriosis at the time of laparoscopy.