Endometriosis

Chronic disease as a cause of infertility

Endometriosis occurs when tissue similar to the lining of the uterus (med. endometrium) grows elsewhere. It can appear anywhere, but is most common on the uterus, fallopian tubes and ovaries, peritoneum, bowel and bladder. These endometriosis sites grow and bleed so that over time the becomes inflamed and scarring ensues. Not only is the condition often hard to diagnose and very painful, the tissue changes make fertilisation or implantation of an embryo difficult for some women.

What are the possible causes of endometriosis?

We don't know the reason some women and people with female organs get endometriosis. It's possible that these tissue changes occur because of one of the following reasons:

• 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 development of endometriosis suggest that there is no single cause. It is much more likely that an interplay of different factors causes endometriosis. Of course, genetic factors are also a big reason as to why some women are more at risk of developing 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: Diagnosing endometriosis typically involves an abdominal examination (laparoscopy). During this procedure, smaller endometrial sites can be removed, for instance by laser or high-frequency current.

• Treatment: If larger sites are found which can't be taken care of this way, then surgery may be required e.g. laparotomy.

Of course, we prioritise protecting the sexual organs of patients wanting to fall pregnant. In some cases, we will need to leave some endometrial tissue if it's on the uterus or fallopian tubes. If this is the case, we recommend a cycle of IVF after the endometriosis treatment.

Endometriosis – Facts and figures

Source: Endometriosis Research Foundation, Germany

• After uterine fibroids (benign tumours found in the uterus), endometriosis is the most common gynecological disease.

• An estimated 7-15% of all women of reproductive age have endometriosis. Due to the varied and complex nature of the symptoms, many are never diagnosed.

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

• Endometriosis often remains undiagnosed for a long time. On average, it takes six years from the moment of first symptoms to diagnosis.

• Endometriosis can result in infertility problems. Patients can also suffer from the physical symptoms and pain of endometriosis without having fertility problems.