Endometriosis and Infertility


What is Endometriosis?
Endometriosis is a condition that affects approximately 5-10% of reproductive-aged women and up to one third of women with infertility.

Women with endometriosis can experience painful periods that often are not relieved with over-the-counter pain medications. Women with this condition may also suffer from pain with intercourse and/or bowel movements.
Endometriosis is caused by cells from the lining of the uterus found in various locations in the abdomen and pelvis, commonly on the ovaries. Surgical visualization of endometriosis implants is the mainstay of diagnosis of the condition.
Endometriosis and Infertility?
Endometriosis has long been associated with infertility, but the cause still remains unclear. Theories of infertility and endometriosis include tubal damage from inflammation and poor implantation due to inflammatory mediators within the uterus. Some women with endometriosis will conceive spontaneously, while others experience significant difficulty and require fertility treatment. Studies suggest the pregnancy rates per treatment cycle may be significantly reduced in women with endometriosis compared with women without the disease.
A subset of women with endometriosis will require in vitro fertilization (IVF), which has been shown to have the highest pregnancy rates per cycle of all fertility treatments. Some studies have illustrated a lower pregnancy rate after IVF in women with endometriosis than in other women of similar age utilizing the same treatment. Not only is the total oocyte (egg) number at oocyte retrieval decreased in these women, but implantation rates appear to be lower as well. Overall, however, the pregnancy rates per cycle in endometriosis patients are still significantly higher than those experienced in a natural cycle.
Pioneering work performed at CCRM has demonstrated improved outcomes in a group of endometriosis patients undergoing IVF after use of specific medications prior to preparation for frozen embryo transfer.
How is Endometriosis Treated?
Several treatment options exist for women with endometriosis pain. Surgical treatment, usually performed through a laparoscope, has been shown in many to decrease pain for a period of time and may enhance fertility. Some hormonal medications may also decrease pain symptoms, but most preclude conceiving a pregnancy since they inhibit ovulation. Such treatments include oral contraceptive pills, progesterone-only pills, aromatase inhibitors, and an injection called Lupron (leuprolide acetate). Each medication has its own unique side effect profile, and patients must be aware of these effects prior to starting therapy. Physicians at CCRM have served as lead investigators in research involving exciting new oral medications to treat symptomatic endometriosis that may soon become available and may potentially play a role in enhancing fertility.

By Dr. Brian Levine

Founding partner and practice director of CCRM New York