Endometriosis is the leading cause of infertility. It is estimated to occur in 10% of women and may be seen in families. It occurs when the lining of the uterus (endometrium) grows in places it is not suppose to be. It grows between the bladder and the uterus, the rectum and the uterus, on ovaries and even on the bowel. There are several theories as to how it gets where it should not be. As it grows, it causes inflammation and scar tissue resulting in pain and infertility.
Women with endometriosis may experience pain before, during or right after a cycle, painful intercourse or even painful urination or bowel movements. Many women have minimal symptoms and only find out they have endometriosis after unsuccessfully trying to conceive. The degree of endometriosis does not usually correlate with the amount of pain, symptoms or ability to conceive. Endometriosis can only be diagnosed surgically. It cannot be seen on ultrasound, CT Scan or MRI. Conventional 2D laparoscopy is not as good as Robotic 3D laparoscopy in visualizing lesions of endometriosis.
There are many women who were told they had no reason for their pain or infertility (after a conventional laparoscopy), when in fact they had endometriosis. Laparoscopy is also not as good at surgically treating endometriosis lesions. In the past, attempts were made to burn or vaporize these lesions laparoscopically. We now know the best treatment for both pain and infertility is surgical excision of endometriosis. Surgical excision is best achieved robotically.
There is a period of enhanced fertility right after surgery for endometriosis of about 3-6 months. A large collection of endometriosis on the ovary is called an endometrioma or chocolate cyst. Many women have had an ovary removed for this reason. This is not a good situation for a woman who is trying to become pregnant (especially if she gets endometriosis on her other ovary).
My Advice for Women Considering Surgery for Possible Endometriosis/Infertility:
- Find a surgeon who offers a minimally invasive robotic approach, and who will resect as much endometriosis as possible
- If you have an endometrioma (or two) – find a surgeon who will save your ovary(s) and dissect off the endometrial cyst(s)
- Be prepared and willing to try and get pregnant right after surgery
- Ask your doctor to assess your tubes intraoperatively by performing a chromotubation (flushing dye through the tubes to see if they are open and/or to open them)
- Don’t forget about your partner – make sure he has a normal semen analysis (by a reproductive lab)
- Remember – once you have endometriosis, you always have endometriosis. Don’t forget to treat your endometriosis when you are not trying to conceive. If your mom had endometriosis and you have bad cramps/periods, see your doctor to consider treatment now. Hopefully you may prevent infertility in the future!