Endometriosis and Infertility

Endometriosis ..... the bane of women who seek fertility.

Well, here's a success story. Lady comes with chronic pelvic pain and primary infertility. Laparoscopy revealed Stage I endometriosis and patent fallopian tubes. The endometrial spots were ablated with diathermy.

The lady came back to see me in her next menstrual cycle, still concerned of the mild pelvic pain that she had. I reassured her and sent her back, advising her to concentrate on her fertility. This is what happened 9 months later :-)

Well, she was lucky enough that it was just stage I.

Note: Photo taken with mother's permission. DO NOT REPRODUCE.

Some notes for students / visitors:

1. About 40% of women who undergo laparoscopy for infertility are found to have endometriosis

2. Infertility afflicts only about 40% of all women with endometriosis

3. It is difficult to draw parallels between severity of endometriosis (as seen laparoscopically) and the degree of infertility

3. Do not brand ALL women with endometriosis with infertility. We, as doctors & students, are biased by the fact that we normally see the 'problematic' ones in the wards and clinic. Remember, the majority DO NOT have infertility and never come to see us save for some who have chronic pelvic pain or severe dysmenorrhoea!

Update (October 2015): the role of treatment in minimal / mild endometriosis to improve fertility remains UNCLEAR. Each case should be assessed based on its own merit. Many women with minimal / mild endometriosis do conceive without much intervention. Question is, how does one know its minimal / mild endometriosis without looking into the pelvis? Catch 22