Causes of infertility

Endometriosis

The term endometriosis refers to a benign and common disease in which cells like the ones that line the inside of the womb are established outside the womb e.g. on the ligament supporting the uterus. in the ovaries, tubes, pelvis, bowels, bladder, etc. In patients with endometriosis, these cells, like the endometrium, respond to the monthly hormonal changes. When the woman with endometriosis menstruates, the endometrium is shed in the form of a period, the endometriosis breaks down in the same way but because these cells are trapped inside, and cannot escape, they form swellings filled with dark blood (known as chocolate cysts) and induces chronic inflammatory reaction and adhesions which may damage the tubes.

Endometriosis tends to occur in women who are in their 30s and early 40s, but occasionally occurs in those under 30 years of age.

Some patients with endometriosis may have no symptoms; some may experience considerable pain during their periods or during intercourse and their periods tend to be heavy.

On vaginal examination their may be tenderness and thickening of the supporting ligaments of the uterus in women with endometriosis. Ovarian cysts may also be felt by the doctor.

The majority of women with endometriosis are fertile. However, some women may experience difficulty becoming pregnant.

How does endometriosis cause infertility?

The anatomical distortion caused by endometriosis, specially when it is moderate and severe, could explain a mechanical cause of infertility, the precise mechanism by which minimal and mild endometriosis affect fertility is not fully understood. It is possible that endometriosis adversely affect the egg development, sperm binding to the egg, fertilization, tubal function and embryo implantation.

Diagnosis

The only means of diagnosis of endometriosis is by laparoscopy, which assesses the severity of endometriosis and the condition of the Fallopian tubes. There are a number of different classification systems for endometriosis, but the most widely used is that of the American Society for Reproductive medicine (ASRM) in which endometriosis is classified into four stages: minimal, mild, moderate and severe. There is little correlation between the severity of symptoms and extent of the endometriosis.

Ultrasound scans, CAT scans, or MRI scans, can identify cysts on the ovaries. However, these techniques can not be used to make a definitive diagnosis of endometriosis.

Incidence

4-8%

Causes

Cause is unknown. However, the most widely accepted explanation for endometriosis is that viable cells from the lining of the womb pass upwards into the Fallopian tube and out into the pelvic cavity where they settle down. In most women these cells will be destroyed by the woman's immune system. However, in some women, these cells implant and proliferate, possibly due to a disorder of the womans' immune system.

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