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The Relationship Between Infertility And Endometriosis

While endometriosis has long been regarded as a risk factor for infertility, a causal relationship between endometriosis and infertility has not been proven.  What do we know for sure about the connection between endometriosis and infertility?  We know that there is an increased prevalence of endometriosis in women with decreased fertility compared with women who have given birth.   This extends beyond a decreased fertility rate by "natural" conception.  Even though the fallopian tubes are bypassed with in vitro fertilization (IVF), a reduced implantation rate per embryo after IVF has also been demonstrated in women with moderate to severe endometriosis compared with women without endometriosis.  In addition, a relatively increased fertility and pregnancy rate has been demonstrated in women with mild to moderate endometriosis who have had surgical treatment.

What is it about endometriosis that increases the risk of infertility?  There may be several factors.  First, women with moderate to severe endometriosis often develop pelvic adhesions or scar tissue.  This may impair the function of the fallopian tubes and even the ovaries.   There are probably many other factors which have yet to be identified or confirmed.

Endometriosis may also simply be diagnosed more frequently in women being evaluated for infertility.  It is not known exactly how common endometriosis is in women in general because it is difficult to diagnose.  Estimates are that 8 to 10% of women of reproductive age may have endometriosis in the United States.  Women with infertility, however, are very likely to have a laparoscopic examination, making endometriosis relatively easy to diagnose.  Several studies have show that endometriosis can be found in anywhere from 30% to 71% of women being evaluated for infertility.  Of these, the range of women with infertility and moderate to severe endometriosis was 19% to 43%. In these studies, women who had already given birth (secondary infertility) were less likely to have endometriosis than women who had not previously given birth.

Created: 10/30/2003  -  Donnica Moore, M.D.

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