Dear Dr. Ron:
I am 28 years old and I've been actively trying to get pregnant for the past 2 years. I recently underwent a laparoscopy by my gynecologist. She told me that I had minimal endometriosis, but that my ovaries and tubes looked normal. She told me that endometriosis is associated with infertility, but I don't really understand the connection.
--Maria in Seattle
Most fertility specialists don't completely understand the link between minimal endometriosis and infertility
The most recent theories regarding the endometriosis-infertility link focus on the fact that endometriosis may lead to a form of mild inflammation within the pelvis. In some women, the presence of certain inflammation hormones, called cytokines, may interfere with normal reproductive processes.
Such hormones may have a negative effect on follicle and egg development, egg-sperm binding and fertilization, normal tubal function, and even implantation.
In a large prospective clinical study published in the New England Journal of Medicine, it was found that when women were diagnosed and treated for minimal endometriosis, there was a significant improvement in their ability to conceive. However, the detailed statistics in the article found that fertility did not completely return to normal, suggesting there might be other factors related to endometriosis and infertility.
In our experience, since endometriosis appears to be so common, a detailed laparoscopic assessment may be warranted in many patients with infertility. When endometriosis is found, it can be treated with the laser or cautery.
In addition, the fallopian tubes may manifest subtle abnormalities, including anatomic distortion and "stickiness", or agglutinations in the fimbria (fingers). By gently pushing some dilute dye through the uterus and tubes, the ends of the tubes can be closely evaluated for agglutinations and normal patency during the laparoscopy procedure.
Maria, treatment options for you could range from expectant management after the laparoscopy (in other words, a wait-and-see approach), to ovulation induction with clomiphene or gonadotropins, to more aggressive treatments like in vitro fertilization (IVF). I would recommend that you continue to seek good information regarding your fertility care, both through your gynecologist
Dr. Feinberg would like to answer the numerous questions he receives related to PCOS and fertility. However, the best medical advice you could obtain comes from your personal physician who knows your medical history best. A list of Board-certified reproductive endocrinology and infertility specialists throughout the country can be found at http://www.socrei.org