Endometriosis is a disease where tissue similar to the lining of the uterus grows outside the uterus, causing pain and/or infertility. Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally. Endometriosis lowers fertilization, implantation and pregnancy rates compared with tubal factor. Women with endometriosis have reduced fecundity. In many cases it distorts the ovaries and theviducts. In pelvis especially around oviducts adhesions are found that hinder the approach of ova to enter the oviducts.
Diagnosis is usually based on clinical evidence. These are best assessed by pelviscopy which visualizes all the pelvic structures and areas around oviducts. Sonography may give some idea.
About
Management
There is no agreement on standard treatment. Various forms of medical treatments have been tried over the years. GnRH agonists reduce endometriosis to great extent. Medical therapy provides no benefits & delays the conception. Surgery is recommended which can be extensive.
Women with mild endometriosis are usually treated similarly to women with unexplained
infertility. Super ovulation followed by IUI or IVF is favored treatment.
If there are adhesions in the pelvis between the ovaries and the fimbrial ends of the tubes, they require surgical removal. Pelviscopic surgery is preferred. In multiple dense adhesions IVF is the choice.