Endometriosis and Your Fertility

March is National Endometriosis Awareness Month. In this two-part blog, we provide information on this common condition and how it affects a woman’s fertility.  


Endometriosis is a relatively common gynecological condition affecting women during their reproductive years. The cause of endometriosis remains unclear and controversial. Endometriosis is defined as the presence of endometrial tissue (cells making up the uterine lining of the uterine cavity), getting outside the uterus, and growing on fallopian tubes, ovaries, bowel, bladder and the pelvic tissue linings (peritoneum).

This endometrial tissue growing outside the uterus is affected by the woman’s monthly hormone changes, just like the endometrial tissue inside the uterine cavity. The endometrial tissue (both inside the uterus and outside) initially thickens during the early phases of the menstrual cycle but then sheds and bleeds during menstruation. This misplaced endometrial tissue implanting and growing on the tubes, ovaries, bladder, bowel and the lining within the peritoneal cavity, results in monthly “internal” bleeding. Several reports in the medical literature suggest that endometriosis may be related to impairment or deficiencies in the immune system. The immune system reacts to the bleeding and tissue, often causing scar tissue to form. The endometrial implants and scar tissue often lead to adhesions and distortion of pelvic structures, moderate to severe pain if close to nerves and infertility. However, the immune system’s response to endometriosis may also play a negative role in terms of proper egg fertilization in the tubes and/or implantation of embryos, even with In Vitro Fertilization (IVF)


Classical pain symptoms may include painful periods (dysmenorrhea), painful intercourse and intermittent pelvic pain throughout the month.  Unfortunately, there is no clear correlation between the severity (stage) of endometriosis and the severity of the symptoms. Mild endometriosis (stages I and II) can occasionally cause considerable painful symptoms, while some women with moderate or severe stages of endometriosis (III and IV) may be relatively symptom-free. For this reason, it can occasionally be challenging to make the correct diagnosis. 


Based on symptoms and ultrasound evidence of ovarian cysts (endometriomas) and/or blood tests (CA-125), one can be suspicious of endometriosis. However, laparoscopic surgery is the only definitive method to diagnose endometriosis and determine its severity, as well as identify adhesions affecting the fallopian tubes.

In my next blog, I'll talk about endometriosis, fertility and possible treatments to help achieve a pregnancy.