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According to a University of Queensland study, women with undiagnosed severe endometriosis will have difficulty falling pregnant without IVF. Endometriosis is often underdiagnosed as painful symptoms of premenstrual syndrome or other conditions.Early detection and IVF treatment in women with moderate to severe endometriosis have better chances for conception as compared to women who wait to get pregnant naturally.
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What is Endometriosis?
Endometriosis is a condition where tissue like endometrium starts to grow outside the uterus. This tissue grows inside ovaries, fallopian tubes, and Pelvis. Endometrial tissue can also develop in other areas of the body such as the digestive tract, the lungs and around the heart. Endometriosis can affect women at any age, but particularly it occurs in reproductive years 25 to 35 year.
Underdiagnosed endometriosis results in formation of scar tissue which can interfere with normal function of reproductive organs, making natural conception problematic.

Causes of endometriosis
The causes of endometriosis are unknown. Genetics contribute to endometriosis; it is inherited from the mother in some of the cases. Autoimmune conditions can also cause endometriosis.
According to one proposed theory retrograde menstruation can cause endometriosis. Retrograde menstruation is the backward flow of blood from fallopian tubes to abdomen. There is no clear evidence about this theory of retrograde flow.
Other lifestyle factors contribute to endometriosis are:
(i). First menstruation before 11 years
(ii). First pregnancy in the late 30s
(iii). Heavy alcohol consumption
(iv). Low body weight
(v). Alteration in immune cells

Symptoms of endometriosis
Symptoms vary from mild, moderate to severe in each woman. In some women there are no symptoms. Mild symptoms can be experienced by women who are in a later stage of disease. Whereas agonising pain can be experienced at an early stage of disease. Symptoms are not specific with the stage of disease.
Symptoms are as follows:
(i). Lower abdominal pain
(ii). Pain before, during and after periods
(iii). Abdominal cramps
(iv). Heavy bleeding during and in between periods
(v). Infertility
(vi). Pain after sexual intercourse
(vii). Lower back pain which gets severe during periods
(viii). Bowel and urinary disorders
(ix). Painful urination
(x). Generalise fatigue and malaise
(xi). Nausea and vomiting

Diagnosis of endometriosis

Symptoms of endometriosis mimic symptoms of other conditions such as ovarian cyst, pelvic inflammatory disease, and irritable bowel syndrome. Endometriosis can be carefully ruled out through detailed history and other diagnostic measures like pelvic examination, ultrasound, magnetic Resonance Imaging (MRI), laparoscopy and biopsy.
In Pelvic examination, your gynaecologist can feel the cyst or scars manually. Ultrasound or MRI are effective but definitive diagnosis is made through laparoscopy. Laparoscopy is a small surgical procedure performed under general anaesthesia. Small incision is made on the abdomen at the navel area and a laparoscope is inserted into the abdominal cavity. Pelvis and abdomen are directly examined for endometrial implants. During laparoscopy, tissue from the endometrial implant is removed for biopsy. Biopsy can confirm endometriosis.

Treatment of endometriosis:
Endometrial implants trapped in the pelvic region form scar tissues, adhere to other reproductive organs. The cysts may grow and release inflammatory substances. It may pose difficulty for eggs to fertilize. Inflammation of ovaries, prevent ovulation and release of egg.
On the other hand, endometriosis leads to inflammatory changes in the pelvis, which might be the reason for infertility. Unfavourable conditions for egg, sperm, and embryo make the conception more difficult as well as it interfere with implantation.
In this way, endometriosis causes infertility or problems in conception in the majority of women.
Pain medications: Over the counter medicines will help to counteract pain of endometriosis. Long term use of pain medication is not recommended. If you want to conceive or if you are pregnant, the doctor will prescribe other medication
Hormonal therapy: Hormonal medications are used to manage endometriosis symptoms. Your gynaecologist will ask you to stop hormonal medication if you are planning pregnancy.
Laparoscopy: It is a minor surgical procedure in which a fibre optic laparoscope is inserted into the abdominal cavity. The endometrial implants are removed from the various areas. After laparoscopy, in many women chances of getting pregnant are increased. Whereas in some women recurrence of cyst is common; and it needs surgical intervention to remove it.
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In vitro fertilization: In patients of endometriosis in vitro fertilization or IVF is the first line treatment. IVF is a scientific method in which fertilization is carried out outside the body. First step of IVF involves fertility medications to mature follicles. It is a complex series of procedures in which ovulation is induced, and the egg is removed from the uterus. Eggs are allowed to meet with sperms in laboratory culture and fertilize. Embryo forms generally in 3-5 days then it is implanted into the uterus. The Patient is closely monitored if she conceives in 15 days after implantation. One IVF cycle takes about 3 to 4 weeks.
One does not prevent endometriosis, but early detection is beneficial to improve quality of life. Improving fertility is topmost goal priority at the same time challenge in women with endometriosis. Women who are diagnosed with endometriosis can opt for IVF. Consult Dr. Richa Singh, IVF doctor in Lucknow.


Why is endometriosis painful?
Dr. Richa Singh, IVF doctor explained the reason for pain in endometriosis, the growth outside the uterus gives response to the menstruation cycle the same way the endometrium does. The outgrown tissue bleeds, breakdown but not able to escape. The broken parts are also called Endometrial implants. It gets accumulated in the pelvic region causing inflammation, pain, and scar formation.

Is hysterectomy required to treat endometriosis?
No, a hysterectomy is not required. In case a woman with endometriosis does not want to become pregnant, doctors may recommend removal of the uterus and possibly the ovaries only if other treatments remain ineffective.

Is endometriosis a cancer?
No, endometriosis is not a cancer. But according to research women with endometriosis may be at a greater risk of developing gynaecological cancers. To know more about your risks, consult your gynaecologist.
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