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Endometriosis  

Endometriosis is condition where endometrial tissue which normally lines the uterus , is found outside the uterus like ovary, tubes and in the abdominal cavity . As a result when ever menstruation occurs , just like endometrial lining bleeds , there is bleeding in the other sites also. As a result leading to scar formation and obliterating normal anatomy of tubes and ovaries which lead to impaired ovulation and blocked tubes .

This condition is predominantly found in women of reproductive age, from all ethnic and socialgroups . The associated symptoms can impact on general, physical, mental & social well-being .

Some women present with severe pain during periods , abnormal menstruation, and also inability to conceive . Some women, however, have no symptoms at all .

According to the severity of adhesions endometriosis is classified as minimal , mild , moderate and severe diagnosed by laparoscopy .
Endometriosis is more common in infertile couple . Infertility associated with endometriosis is more common in women with severe forms of the disease . It causes anatomical block of tubes and distortion impairing ovum pick up .
Alternatively, endometriosis may affect fertility through the production of hormones and other substances that have a negative effect on ovulation , fertilization of the egg , and/or implantation of the embryo.
Treatment must be individualized , taking the clinical problem in its entirety into account , including the impact of the disease and the effect of its treatment on quality of life .

Treatment of endometriosis-associated infertility in confirmed disease :

Treatment of endometriotic lesions :

1.Hormonal treatment :

Suppression of ovarian function to improve fertility in minimal-mild endometriosis is not effective and should not be offered for this indication alone .

2.Surgical Treatment :

Ablation of endometriotic lesions plus adhesiolysis to improve fertility in minimal-mild endometriosis is effective compared to diagnostic laparoscopy alone .

Laparoscopic cystectomy for ovarian endometriomas > 4 cm diameter improves fertility compared to drainage and coagulation . Coagulation or laser vaporization of endometriomas without excision of the pseudo-capsule is associated with a significantly increased risk of cyst recurrence .

Post-operative treatment :

Compared to surgery alone or surgery plus placebo, post-operative hormonal treatment has no effect on pregnancy rates .

Assisted reproduction in endometriosis :

A . Treatment with intrauterine insemination (IUI) improves fertility in minimal–mild endometriosis . IUI with ovarian stimulation is effective but the role of unstimulated IUI is uncertain .

B. IVF is appropriate treatment especially if tubal function is compromised, if there is also male factor infertility, and/or other treatments have failed .