• the right doctor
• basal fertility testing
• female symptoms
• additional tests for women
• female diagnosis
  • cycle disorders
  • pathology (abnormalities) tuba & uterus
  • cervical mucous problems
  • endometriosis
• male symptoms
• additional tests for men
• male diagnosis
• unexplained subfertility

endometriosis

The lining of the womb (uterus) is called the endometrium or the uterine membrane. Endometriosis is a condition whereby endometrial tissue grows outside of the womb, for example in or on the ovaries, the fallopian tubes, the bladder or the kidneys. Although outside the womb, this tissue – termed endometrioses - undergoes the same cyclical changes as the normal endometrium. However, it cannot be shed in the way that the endometrium is normally shed via the cervix and the vagina during a menstrual period.

Endometriosis can reduce the chance of pregnancy in a number of ways. An anatomical defect as a result of endometriosis can block the fallopian tubes and prevent the sperm cells from reaching the woman’s egg and fertilising it. According to some theories, the tissue can secrete substances that, although will not necessarily exclude fertilisation, may reduce its chance of occurring.

• symptoms
• cause
• treatment

symptoms

Endometriosis can cause painful, heavy periods as well as pain during intercourse, although it can also be present without causing any symptoms. Some of the most serious cases of endometriosis are completely without symptoms.

Examination
Endometriosis can be confirmed and sometimes treated by an exploratory operation (laparoscopy). Sometimes at laparoscopy a biopsy may be needed for confirmation

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cause

The most commonly accepted (but not proven) theory about the cause of endometriosis is that the menstrual blood flows up into the fallopian tubes instead of down through the vagina leading to the presence of endometrial tissue outside the womb (retrograde menstruation). The subsequent implantation and growth of this tissue on the ovaries, uterus and other abdominal organ results in endometriosis. Researchers also believe that it could be hereditary, given that female family members sometimes have the same disease.

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treatment

Endometriosis can be treated in various ways, depending on the severity of the condition, wishes of the patient and the desire for pregnancy.

• Drug treatment – Drug treatment can include:
  - Analgesics to manage the symptoms of pain
  - Oral progestogens or the combined oral contraceptive pill to mimic a pregnancy
  - GnRH agonists . These drugs work by suppressing the hormonal changes that would otherwise promote the growth of the endometrial tissue. In doing so, the drugs work in the opposite way to fertility stimulating drugs. If this treatment is recommended, it is important that you understand you cannot get pregnant and will have to wait until the treatment is complete before trying. On the other hand, those hormone treatments that are used to promote fertility increase the endometrioses. For many women this is a serious dilemma. Often the severity of the symptoms determines which treatment gets priority.
• Surgical treatment - Endometrioses or other adhesions can be surgically removed by laparoscopy or laparotomy. This is not always completely sucessful. After the surgery, the doctor can prescribe drugs to stimulate ovulation and increase the chance of a pregnancy.
• Assisted reproduction technology – in vitro fertilisation (IVF) is recommended if the fallopian tubes are damaged as a result of endometriosis. However, the more severe the endometriosis, the lower the chance of becoming pregnant.

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