Course / What is Endometriosis?
Definition: Endometriosis occurs when endometrial-like tissue implants outside the uterus, most commonly on the ovaries, fallopian tubes, and pelvic lining.
Pathophysiology: These ectopic tissues respond to hormonal cycles, leading to inflammation, formation of scar tissue, and adhesions.
Theories of Development: While the exact cause is not fully understood, key mechanisms include:
Retrograde menstruation: Menstrual tissue flows backward into the pelvic cavity.
Coelomic metaplasia: Cells outside the uterus transform into endometrial-like tissue.
Genetic and immune factors: Predisposition may influence tissue implantation and inflammatory response.
Endometriosis can affect fertility through multiple mechanisms:
Anatomical Distortion: Scar tissue and adhesions can alter pelvic anatomy, affecting the fallopian tubes and ovary function.
Ovarian Function: Endometriomas (cysts on the ovaries) can reduce ovarian reserve or impair egg quality.
Inflammatory Environment: Chronic pelvic inflammation may interfere with ovulation, fertilization, or implantation.
Impact on IVF Outcomes: While IVF can bypass some mechanical issues, severe endometriosis may reduce egg retrieval success and embryo quality.
Fertility management for patients with endometriosis often involves a combination of surgical intervention, medical therapy, and assisted reproductive technologies, tailored to individual severity and reproductive goals.
Prevalence: Endometriosis affects approximately 10–15% of reproductive-age women, making it a significant factor in infertility evaluations.
Risk Factors:
Family history of endometriosis
Early onset of menstruation
Short menstrual cycles or heavy periods
Delayed childbearing or nulliparity
Undiagnosed Cases: Many women may have mild symptoms and remain undiagnosed until fertility evaluations.
Early identification and management of endometriosis are critical for optimizing fertility and planning interventions such as IVF or surrogacy.
Early Assessment: Women with chronic pelvic pain, dysmenorrhea, or infertility should undergo evaluation for endometriosis.
Surgical Intervention: Laparoscopic removal of endometriomas or adhesions can improve fertility outcomes in selected cases.
Optimize IVF Protocols: Fertility specialists may adjust stimulation protocols to account for reduced ovarian reserve or inflammatory pelvic environments.
Consider Surrogacy When Needed: For severe cases or compromised uterine function, gestational surrogacy provides a reliable alternative for achieving parenthood.
Monitor Ovarian Reserve: AMH and antral follicle counts are important to evaluate reproductive potential in endometriosis patients.
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