Endometriosis

Endometriosis is an abnormal gynecologic condition that affects 7-10% of all reproductive-aged women. Endometriosis is a condition that can cause pain (painful periods or painful sex) and/or infertility. Some women will have both pain and infertility and some women will have neither.

Endometriosis accounts for about 20% of all causes of infertility. However, of the infertile couples who have a normal semen analysis, normal ovulation and patent fallopian tubes, about 80% will have endometriosis as the cause of their infertility.

The exact cause of endometriosis remains unknown. Theories as to its development include retrograde menstruation and coelomic metaplasia. There is also a genetic tendency toward endometriosis as well.

Endometriosis can only be definitively diagnosed at time of surgery. The most common surgical procedure to diagnose endometriosis is called a laparoscopy where a lighted tube with a camera is placed into the abdomen. Some laparoscopic pictures of endometriosis are shown below. The endometriosis implants are the dark areas. These implants can be surgically treated with laser at time of the laparoscopy which can double the pregnancy rate (Marcoux S, NEJM 1997;337:217-22.). Unfortunately, endometriosis is not cured but only treated with the laser. There is a recurrence rate of 50-60%. Sometimes a hysterectomy with removal of both tubes and ovaries is required to treat the endometriosis if the pain is severe.