Endometriosis
There is a strong relationship between endometriosis and sterility, because it is mentioned that 10% of women suffer from it and 35% of sterile women have it.
Endometriosis appears when the tissue that normally lines the uterus appears in other organs: ovaries, Fallopian tubes, bowel, bladder, peritoneum and, sometimes, in organs further away such as the lungs. It can affect all menstruating women, even the youngest.
It is important to highlight that most women suffering from endometriosis have symptoms such as increasingly painful menstruation (dysmenorrhoea) which generally does not respond to the usual treatment, menstruations that are abnormal in intensity whether abundant or limited, sterility and pain during sexual intercourse (coitalgia). It can also cause blood cysts in the ovaries, also called chocolate cysts because of their brownish appearance.
Diagnosis can be made only by means of direct visualisation of the lesions, which in some cases are of minimal size, and they can be identified only by means of laparoscopy.
It is not clear why slight to moderate endometriosis is associated with sterility, but it is suggested that the effect on the tubes’ functionality is caused by the inflammatory and wound-healing component of the endometrial tissue. However, the presence of the family hereditary factor and the possibility of poor oocyte quality are also common.
Surgical treatment by laparoscopy (diathermy/argon/exeresis) improves the patient's fertility. This is not the case in the use of medication, which is more useful for treatment of pain.
In the case of severe endometriosis, particularly if there are chocolate cysts, surgery may be essential before starting reproductive treatment. This assessment must be made by the gynaecologist, taking into consideration the cyst size and the ovarian reserve or responsiveness of the affected ovary. IVF is an appropriate treatment for sterility associated with endometriosis when other techniques have failed. Gestation is an excellent temporary therapy to improve endometriosis.
It is very important to know that, although this disease has no cure, according to each patient's needs the treatment is aimed at relieving pain, particularly menstrual pain, preventing it from increasing, and if so desired, achieving pregnancy.
The earlier the diagnosis is made, it is possible to avoid the damage caused to the pelvis by the disease and improve the prognosis to achieve pregnancy. Thus, sterility due to endometriosis can be prevented.