Women's Health Q&A by Dr. Stoppler
The mechanism for impaired fertility may involve both anatomic distortion from pelvic adhesions, endometriomas, and the production of substances (for example, prostanoids, cytokines, and growth factors) which are "hostile" to normal ovulation, fertilization, and implantation.
There has been a long-running controversy regarding how endometriosis might be related to infertility. Endometriosis is more common in infertile compared to fertile women, but the condition usually does not fully prevent conception.
The reasons for a decrease in fertility are not completely understood, but might be due to both anatomic and hormonal factors. The presence of endometriosis may involve masses of tissue or scarring (adhesions) within the pelvis that may distort normal anatomical structures, such as Fallopian tubes, which transport the eggs from the ovaries. Alternatively, endometriosis may affect fertility through the production of hormones and other substances that have a negative effect on ovulation, fertilization of the egg, and/or implantation of the embryo. Infertility associated with endometriosis is more common in women with severe forms of the disease.
Most women with endometriosis will still be able to conceive, especially those with mild to moderate endometriosis. It is estimated that up to 70% of women with mild and moderate endometriosis will conceive within three years without any specific treatment.
Treatment options for infertility associated with endometriosis involve a combination of medical therapy, surgery, and assisted reproduction techniques. While there has been controversy in the past regarding the effectiveness of treatment for endometriosis on fertility rates, current studies support an increased fertility rate when endometriosis is treated by surgical methods supplemented by assisted reproductive technology when appropriate.
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Last Editorial Review: 2/26/2007
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