Early Endometriosis – Surgical Treatment Leads to Unexplained Fertility Outcomes

Fortunately for those who have experienced difficulty conceiving, many significant advances have been made in reproductive diagnosis, treatment and technology. These advances have helped fertility treatment centers to determine the individual causes of infertility and develop an optimum treatment strategy for many couples.

Endometriosis and Unexplained Infertility
However, even in light of these advances, some causes and contributing factors in infertility remain elusive or disputed. Endometriosis, for example, remains a source of controversy. While it is widely accepted that advanced stage endometriosis causes a significant disturbance of the pelvic anatomy which can cause infertility. The impact of early endometriosis is not as clear.

What Is Endometriosis
Endometriosis is a common gynecological disease which occurs in  3-10% of women of reproductive age. In women experiencing infertility, the rate increases to between 20 and 40% of that population. It is defined by the American Medical Association, as the presence of endometrial cells outside of the uterus that may result in pain and infertility.

How Does Endometriosis Develop?
Although not fully not understood, it is thought that the disease develops as a result of the drainage of menstrual debris, cells and blood, back into the abdomen and pelvis through the fallopian tubes. Genetics are likely to also play a contributing role, as women with close relatives suffering from the disease are nearly 7 times more likely to develop the disease.

Clinical Diagnosis
There are several possible ways of diagnosing endometriosis, with varying levels of accuracy. A fertility treatment center may base a diagnosis on the presence of pelvic pain, excessive menstrual pain, and painful intercourse. However, not all patients, even with advanced cases experience pain. A physical examination confirm the presence of the disease, but also may not be reliable or conclusive. Frequently, a diagnosis is reached based on the exclusion of possibilities. The most reliable form of diagnosis is surgical.

Does Surgical Treatment of Endometriosis Improve Fertility?
Many studies have been done to determine the pregnancy rate between women who were surgically treated for endometriosis and those using controlled ovarian hyperstimulation and intrauterine insemination, and the verdict is still out. Part of the problem is that a clear understanding of the association has yet to be determined.

However, it has been established that the management of the disease through medications alone does not positively impact a person’s ability to become pregnant. The question then becomes, which is more effective; surgical treatment or COH- IUI? In many randomized trials, fertility treatment centers found that women with early stage endometriosis and surgically treated did see an increased rate of pregnancy, as did those using COH-IUI.

Fertility Treatment Centers Help Develop Treatment Strategy
There is much data to support that ablative therapy is as effective as surgical therapies but must be considered on a case by case basis. Most fertility treatment centers agree that management plans for couples experiencing unexplained infertility and endometriosis must be individualized based on many clinical factors, such as:

• The stage of endometriosis
• The age of patient
• The anatomy
• The duration of infertility
• Other contributing factors

Based on your individual clinical profile, your fertility treatment center will develop a plan that is most likely to yield positive results. Discuss your options with your physician.