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By Lila Havens, Staff Writer, myOptumHealth

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Experts think that as many as four out of 10 women with fertility problems have endometriosis. Severe endometriosis is a known cause of infertility, but even the mild form may make it hard to get pregnant.

Having endometriosis means the type of tissue that lines your uterus (called the endometrium) is growing in other places, too. Endometrial implants usually grow on organs in the abdomen, such as the ovaries, fallopian tubes and intestines. These implants behave like the tissue in your uterus: they bleed each month when you have your period. This irritates the nearby tissue and can cause cysts and adhesions. Adhesions are bands of scar tissue that can bind the ovaries, tubes and other organs together. This may interfere with conception.

Endometriosis often causes pain and abnormal menstrual periods. In some women, though, infertility is the first symptom they have.

Treatment steps for infertility

Doctors often suggest a stepwise approach to treating infertility caused by endometriosis. In general they start with the easiest and cheapest methods, such as lifestyle changes or minor surgery. If these don't work, more invasive and costly methods may be tried. This includes in vitro fertilization (IVF).

Step 1: Identify and treat reversible causes of infertility.

Your doctor will check both you and your partner to find and treat any other problems that could cause infertility. If none are found, you may be coached on the best days of your menstrual cycle to have sex. Your lifestyle can affect your fertility, so it's best to maintain a healthy weight, avoid alcohol, not smoke and limit caffeine.

Step 2: Have laparoscopic surgery to remove areas of endometriosis.

Your doctor may suggest laparoscopy to diagnosis and treat the condition. For this procedure, the surgeon makes one or more small incisions in your abdomen and inserts a lighted instrument. The doctor can see any implants and adhesions and remove them at the same time. Your chance of getting pregnant may improve for six to nine months after the surgery.

Step 3: Use fertility drugs along with intrauterine insemination (IUI).

Medications are used to stimulate your ovaries to produce one or more eggs. Then sperm is then put through the cervix directly into your uterus. This increases the chance that it will reach and fertilize an egg.

• Clomiphene (brand name Clomid or Serophene) is the most commonly used fertility drug. You take the pills for five days early in your menstrual cycle. Clomiphene is usually given for six cycles or fewer if you become pregnant during a particular cycle. It can cause side effects, but they are mostly mild. It raises the risk of having twins to about 10 percent.
• Gonadotropins are hormones that may be used if clomiphene doesn't work. They are given as injections. You'll need careful monitoring during treatment. Gonadotropins can cause a serious side effect in which the ovaries become swollen and painful. They also raise the risk of multiple pregnancy (usually twins) to as much as 30 percent. Because of these risks, some doctors prefer to skip this treatment and move to in vitro fertilization if clomiphene fails.

Step 4: Have in vitro fertilization (IVF).

For IVF, you are given drugs that cause your ovaries to make multiple eggs. The eggs are removed from your body body by laparoscopy and mixed with sperm (from your partner or a donor) in a lab. The fertilized eggs are then put into your uterus to grow.

IVF is expensive and time-consuming, but it may offer hope for women with moderate to severe endometriosis who aren't helped by surgery or medication. The main risk of IVF is multiple pregnancy.

The success of IVF depends in part upon your age. It results in pregnancy about 35 percent of the time in women younger than 35. This drops to 15 to 20 percent for women between ages 38 and 40.

Timing of treatment

Several factors will play a role in how quickly you move through the treatment steps. These include:

• Your age. If you are younger than 32, your doctor may want to try each step and give it time to work. If you are 37 or older, you may be in a race against time. You and your doctor may decide to move through the steps quickly.
• Other fertility problems. Your doctor may advise skipping directly to IVF if you or your partner has any other problems that could prevent pregnancy.
• Severity of endometriosis. If it is moderate to severe, IVF may be the best choice if surgery doesn't restore your fertility.

View the original Treating infertility caused by endometriosis article on myOptumHealth.com 

SOURCES:

• American Society for Reproductive Medicine. Endometriosis: a guide for patients. Accessed: 03/18/2009

• American Society for Reproductive Medicine. Drugs for inducing ovulation: a guide for patients. Accessed: 03/18/2009

• Lobo RA. Infertility: etiology, diagnostic evaluation, management, prognosis. In: Katz VL, Lentz GM, Lobo RA, Gershenson, DM, eds. Comprehensive Gynecology. 5th edition. Philadelphia, PA: Mosby Elsevier; 2007. Accessed: 03/18/2009

• American College of Obstetricians and Gynecologists. Treating infertility. Accessed: 03/18/2009