Endometriosis and Infertility
Endometriosis is a condition in which the uterine lining grows outside of the uterus and attaches to different abdominal organs, such as the ovaries, fallopian tubes and intestines. Endometriosis is a chronic, progressive disease that tends to get worse over time and can reoccur after treatment. Endometriosis symptomatology includes: painful menstrual periods, abnormal menstrual bleeding and pain during or after sexual intercourse.
The endometrial tissue outside of the uterus responds to the hormones produced by the ovaries in the same way as the tissue inside of the uterus responds: it swells, thickens and sheds to mark the beginning of a menstrual cycle. The blood that is shed from the endometrial tissue inside of the abdominal cavity cannot be cleaned up, resulting in pools of blood causing inflammation that eventually leads to scar tissue. The scar tissue in the pelvis could block fallopian tubes or interfere with ovulation. Another result from the endometriosis is the formation of ovarian cysts called endometriomas, that may lead to ovulatory dysfunction.
The cause of endometriosis is still a mystery to the medical science. One theory suggests that during menstruation, some endometrial tissue backs up through the fallopian tubes into the abdomen, where it implants and grows. Another theory suggests that it is a genetically determined birth abnormality in which endometrial cells develop outside of the uterus during fetal development.
In order to confirm a diagnosis of endometriosis, a laparoscopy, must be performed. Laparoscopy is an outpatient surgical procedure in which a telescope-like instrument is entered into the abdomen through the belly button. After the initial evaluation, the disease is classified as being: Stage I (minimal), Stage II (mild), Stage III (moderate) and Stage IV (severe), based on the amount and extension of the scaring and diseased tissue found in the pelvis. Based on the stage of the endometriosis, Dr. Gomez determines the best treatment plan, such as: medications (oral contraceptives, progestins, GnRH agonists), laser surgery or assisted reproductive technologies, especially in cases of severe scarring of the fallopian tubes, leading to their obstruction.