How Endometriosis and Fertility Relate

By Karol Cardinson

Many women with endometriosis fail to ovulate, although no one knows if this is a direct result of the disease or if it is coincidental. One thought is that if an ovarian follicle that has been stimulated by luteinizing hormone fails to rupture and expel the ovum, the ovum cannot be fertilized. This is called luteinized unruptured follicle syndrome.

Even if the ovum is fertilized, problems can occur. For instance, when the smooth muscle of the uterus and fallopian tubes becomes irritated, the contractile waves diminish, thus making it difficult for the ovum, fertilized or not, to move along its path to the uterus. Also, excessive contractions of the uterus may prevent implantation of the fertilized ovum.

Other barriers to fertility in endometriosis include:

Irritation and inflammation produced by retrograde menstruation, or by the endometriomata themselves, can cause an immune reaction and formation of an excessive number of macrophages (scavenger cells), which destroy foreign invaders such as sperm.

Various autoimmune responses (a condition in which one is "allergic" to oneself) arise as a result of misplaced endometrium. Auto antibodies prevent implantation or cause the uterus to reject the zygote (fertilized ovum). Endometriosis is now beginning to be regarded as an autoimmune disease, like lupus erythematosus or rheumatoid arthritis.

Increased or overactive prostaglandins can decrease sperm motility. Moreover, ectopic (misplaced) endometrium secretes prostaglandins that affect a number of reproductive mechanisms.

Anatomic distortions and obstructions of the fallopian tubes, as well as anovulation, luteal phase defects, and hormonal abnormalities can inhibit fertility.

And-if you are avoiding having sexual intercourse because it is painful, you're not likely to become pregnant.

Although there is no proof of it, scientists believe that certain lifestyle factors may predispose a woman to infertility resulting from endometriosis; use of intrauterine devices, especially the Dalkon Shield; cigarette smoking; obesity; and possibly cocaine, marijuana, and alcohol use.

If you decide to make an all-out effort to become pregnant, you and your doctor will have to assess how difficult it will be; that is, what are your chances as compared with general statistics? Of course, physicians cannot guarantee that you will get pregnant if you do this or that treatment. But what can happen is that you can improve your odds with certain treatments. - 30525

About the Author:

Sign Up for our Free Newsletter

Enter email address here