Endometriosis is a common condition among infertile women (ranging from minimal to advanced disease) in which uterine cells are found outside of the uterus. This condition can cause scarring and distortion of the fallopian tubes, as well as what are known as “chocolate” cysts of the ovaries (called “endometriomas”). If an endometrioma gets too big (>4.5 cm), it can get in the way of the eggs during ovarian stimulation.
Clinical history (painful periods or pain during sex) can indicate endometriosis, as well as physical examination or ultrasound if an endometrioma is present. But the gold standard for diagnosing emdometriosis is a diagnostic laparoscopy (minimally invasive surgery).
Endometriosis involving the ovaries is one of the leading reasons why women do not respond to fertility medications. The disease can also trigger an immune response leading to failed implantation.
Treatment for endometriosis depends on the severity of the disease, ranging from no treatment to medical treatment to surgery. In most cases, surgery can be done laparoscopically but more advanced cases may require a traditional incision.
Another common, similar condition among infertile women is called “adenomyosis”, which is essentially endometriosis found within the muscle of the uterus itself. This condition is often diagnoses by ultrasound and treated the same way as endometriosis, but surgery is less likely.