Endometriosis is a medical condition that occurs when tissue similar to the lining of the uterus grows outside of the uterus, causing pain and other symptoms. This tissue can grow on the ovaries, fallopian tubes, bowel, bladder, and other pelvic structures. It can cause cysts in the ovary that are easily identified by ultrasound. The cysts are called endometriomas or “chocolate cysts.”
Endometriosis affects an estimated 20-40% of women of infertile women—a huge burden. It can cause significant pain, discomfort, and infertility; which increases in proportion to the severity of the disease. The condition is usually diagnosed in women in their 30s or 40s, but it can occur at any age during the reproductive years.
Endometriosis can affect fertility in both anatomic, hormonal, and biochemical ways. From a structural point of view, it can lead to the formation of scar tissue or adhesions in the pelvic region. This scar tissue can cause the ovaries, and fallopian tubes, to become distorted. This can prevent the pickup and transport of the egg.
Secondly, endometriosis can affect the quality of the eggs or the uterus lining, preventing the fertilized egg to implant and grow properly. Endometriosis can cause inflammation and hormonal imbalances, which can impact the ability of the ovaries to produce healthy eggs, the tubes to transport the egg and embryo, and the uterus to provide a suitable environment for implantation.
Overall, the severity and extent of endometriosis can vary greatly from person to person, and the impact on fertility can also vary. However, for many women with endometriosis, fertility treatments such as in vitro fertilization (IVF) are often necessary to conceive.
Egg retrieval with IVF and fertilization in the laboratory mitigates the impact of implants in the pelvis. This is because the eggs are removed from the inflamed areas in the pelvis. They are isolated and protected from the adverse effects of implants of endometriosis.
Overall, in patients with endometriosis, the pregnancy rates can be increased by 10 to 25% using in vitro fertilization. Despite any scar tissue in the pelvis, IVF can always allow us to retrieve eggs easily. This is because the eggs are retrieved by direct needle aspiration using ultrasound guidance. We expect a sufficient number of eggs that have good implantation rates and increased pregnancy rates. Overall quite satisfactory pregnancy rates and live birth rates can be achieved using assisted reproduction for endometriosis.