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Endometriosis and Infertility - Causes and Overview

Statistics show us that about 40% of women, who have been diagnosed with endometriosis, will experience some degree of infertility. Luckily, not all women who have endometriosis have fertility problems and not all fertility issues are caused by endometriosis.

Many women with endometriosis have no symptoms of the disease and often only find out they have it when it is discovered during the investigation of some other unrelated condition. Similarly, many women who are struggling to conceive discover they have endometriosis when the possible causes for their infertility are being investigated.

Endometriosis impacts on a woman's fertility in a number of different ways. These include:

  • Adhesions
  • Scar tissue
  • Blocked fallopian tubes
  • Prostaglandins
  • Pain
  • Malfunctioning immune system
  • Increased risk of miscarriage

Adhesions are fibrous growths that cause organs and tissue in the abdominal cavity to attach to each other, causing organs to be situated out of place and creating obstructions and pain. If an ovary is moved, even slightly, because of adhesions, it will not be able to drop an egg into the fallopian tube to begin its journey to the uterus. If there are adhesions or endometrial tissue inside the fallopian tubes, they may become partially or completely blocked, which also impedes the progress of eggs to the uterus to be fertilized and implanted. Ectopic pregnancies, where the fertilized egg imbeds into the wall of the fallopian tube instead of the endometrium or wall of the uterus, are more common when endometriosis is present.

The human body is equipped with an active immune system which sees the endometrial tissue as a danger and tries to encase it to protect the surrounding areas. This causes scarring which can also interfere with fertility, depending where the scarring occurs. If scar tissue forms inside the fallopian tubes, the effect will be similar to adhesions in the same area. Scar tissue on the ovaries can affect their correct functioning.

The pain of endometriosis is a big factor in hindering fertility. The strong cramping pain affects the woman's emotions and libido, making her less likely to welcome sexual intercourse. If she has endometrial tissue on or in her vagina, intercourse can be painful and so again, sexual relations may be intermittent and irregular. This obviously reduces her chance of falling pregnant.

Prostaglandins are hormones that are normally secreted by the endometrium when an egg is released by the ovaries; that is, when the woman ovulates. Prostaglandins have an important role in the fertilization of the egg and how well the embryo implants into the endometrium. These hormones are also required for ending each menstrual cycle, correct ovulation, mobility of sperm, causing uterine contractions at childbirth and they also cause the cramps of menstruation. If there is an increase in prostaglandin levels, these functions are affected.

When there is extra endometrial tissue implanted in the abdomen, as occurs in endometriosis, extra prostaglandins will be produced and released, causing problems with fertility. When endometrial tissue occurs outside the uterus, the prostaglandins do not reach the uterus because they are released by the tissue outside the womb. Endometrial implants appear to release the hormones at the incorrect time which also affects fertility. Implants release the hormones a few days later than the endometrium which is believed to be the reason for miscarriage at an early stage.

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