Endometriosis

Endometriosis – chronic disease as a cause of infertility

Endometriosis is a chronic but benign gynaecological problem that occurs in women of reproductive age. This is when tissue similar to the lining of the uterus (med. endometrium) grows on one or more organs. Endometriosis can affect not only the uterus, fallopian tubes and ovaries, but also the peritoneum, bowel and bladder. The tissue growths or lesions designated as endometriosis sites grow and bleed, so that the tissue becomes inflamed and scarring ensues over time. These tissue changes make fertilisation or implantation of an embryo difficult.

What are the possible causes of endometriosis?

The causes of endometriosis are not clear. There are different theories as to why tissue changes occur. These include:

• Spread of endometrial cells in the abdominal organs due to return flow of the menstrual blood (retrograde menstruation)

• Spread of endometrial cells via the blood and lymphatic vessels

• Genetic factors that trigger a lesion

• Malfunctions of the immune system

• Environmental influences – in particular, environmental contaminants, such as PCB, DDT and dioxins, which interfere with the endocrine system

The complex symptoms and the development of endometriosis suggest that there is no single cause for its formation. It is much more likely that an interplay of different factors causes endometriosis.

How is endometriosis treated?

There are two basic treatment options for endometriosis patients suffering from infertility. In minimal endometriosis, the first step is to remove all detectable endometrial tissue and then to see if a pregnancy occurs naturally. If endometriosis is severe or occurs repeatedly, our recommendation is in vitro fertilisation after the surgery to improve the chances of a successful pregnancy.

A consultation and detailed diagnosis are always carried out before the endometrial tissue is removed in order to specify the treatment goals for each patient individually. This is followed by treatment for endometriosis:

• Diagnosis: The diagnosis usually comprises an abdominal examination (laparoscopy). Smaller endometriosis sites can be removed immediately during this procedure, e.g. by laser or high-frequency current.

• Treatment: If the diagnosis indicates extensive tissue changes or growths in areas that are difficult to reach, these are removed through an abdominal incision (laparotomy).

In patients who want to conceive, full preservation of the organs is the highest priority. Severe endometrial lesions on the uterus or fallopian tubes can therefore sometimes not be completely removed. In these cases, the recommendation is artificial insemination after treatment.

Endometriosis – facts and figures

Source: Endometriosis Research Foundation, Germany

• After uterine fibroids (benign tumours), endometriosis is the second most common gynaecological disease.

• An estimated 7-15% of all women capable of reproduction are affected by endometriosis. Many of them are never diagnosed.

• The number of new cases of endometriosis every year is estimated at 40,000.

• Endometriosis often remains undetected for a long time – it takes on average six years from the onset of the first symptoms until diagnosis.

• Endometriosis can result in infertility problems but is not a guarantee. Patients can also suffer from the physical symptoms and pain of endometriosis without having fertility problems.