This is a highly common condition in which tissue lining the uterus (endometrium) grows outside the uterus, into such areas as the ovaries, fallopian tubes, the area between the vagina and rectum and the lining of the pelvic cavity. During menstruation, this excess endometrial tissue bleeds just as if it were normal tissue. Unlike normal tissue, however, it is not shed from the body, but instead becomes fixed to the area. This eventually causes inflammation, pain and scarring of the fallopian tubes, ovaries and surrounding reproductive anatomy.
This involves an examination in which a doctor will assess frequent symptoms of endometriosis including:
Pain before and during periods
- Pain with sex
- Painful urination during periods
- Painful bowel movements during periods
- Other Gastrointestinal upsets such as diarrhea, constipation, nausea.
A minimally invasive surgery called laparoscopy or belly button surgery uses a thin, lighted viewing instrument (laparoscope). The laparoscope is inserted into the pelvic area through a tiny incision made in the belly button. This process allows the doctor to look at endometrial tissue in the reproductive area. The laparoscope can also be used to surgically remove endometrial tissue.
A laparoscopy used to be a common part of the infertility work-up, especially for women with otherwise unexplained infertility. In recent years, this practice has become very uncommon for a variety of reasons, the most important being that even if endometriosis is found and treated, it tends to reoccur quickly. And the improvement in fertility, if any, was minimal. So today, rather than subject all our patients to an expensive and invasive surgery, we will treat patients that might have endometriosis the same way we treat unexplained infertility patients.
On ultrasound, sometimes we can see cysts filled with cloudy fluid within the ovary. These cysts are filled with old blood and known as "chocolate cysts" as the old blood looks a lot like chocolate syrup. If we see these characteristic cysts on ultrasound, we will diagnose endometriosis. Still, surgery is not required unless there is significant pelvic pain. Some advocate removal of cysts if they show signs of growth over time or for cysts larger than 5 centimeters. There is no distinct consensus even amongst endometriosis experts on whether or not or when endometriomas should be surgically removed.
IVF and Endometriosis
In most cases of more severe and extensive endometriosis, we will advocate in vitro fertilization, to help get the eggs, sperm and embryos out of the pelvic environment, which has been shown to be toxic to these cells.
At our Northern California San Francisco Bay Area clinic, PFC's fertility doctors specialize in helping patients with endometriosis. We employ a multi-faced treatment approach and work together to create a personalized treatment plan for each patient.
Some common endometriosis questions include:
- What are some of the warning signs for endometriosis?
- What are the best fertility treatment options for endometriosis?
- How much will endometriosis affect my chances of getting pregnant?
- I have many choices in Northern California's San Francisco Bay Area. Why should I choose PFC?
- And much more... We're here to answer your questions.
Pacific Fertility Center is conveniently located by Fisherman's Wharf and the Embarcadero in the San Francisco Bay Area, with convenient access from many Northern California communities. Sign Up for the next new patient seminar @PFC »
For some patients with endometriosis, IUI in conjunction with fertility medications is a viable option. The fertility medications help to increase the number of eggs produced in a single ovulation cycle. During ovulation, specially prepared semen is deposited into the uterus using a thin catheter. This technique is far more likely to result in a pregnancy than no treatment at all.