Endometriosis is a relatively common disease in the reproductive age women (3-10%) and even more common in the infertility population (20-40%). Endometriosis is defined as the presence of endometrial cells outside of the uterus that can result in pain and infertility.
There are numerous theories to explain how the disease develops. The most accepted one is the drainage of the menstrual debris, cells and blood back into the abdomen and pelvis through the fallopian tubes. Whereas the drainage occurs in most women during their menses, only some women develop the disease. It is difficult to identify those at risk. Genetics play a role in the development of endometriosis, because first degree relatives of affected women are at 6-7 times greater risk of developing endometriosis compared to the general population.
It has been proposed that endometriosis is closely related to a dysfunction in the immune system. Impaired immune response in some women may result in ineffective removal of the endometrial cells from the pelvic area that may result in endometriosis. A number of substances are involves in the pathophysiology of the disease including cytokines, interleukins, TNF and natural killer cells. Exact mechanism of endometriosis pathology is still yet to be determined.
Endometriosis can cause pain by involving the nerves in the pelvic area, causing irregular bleeding into the tissue they are attached to, or by releasing inflammatory substances into the peritoneal-pelvic cavity. Pain can be associated with menses or intercourse. Alternatively, pain can be intermittent or continues depending on the extent and the location of the disease.
Endometriosis can cause infertility by distorting tubal and ovarian anatomy that may result in the prevention of egg capture by the fallopian tubes. It may interfere with early egg and embryo development as well as affect implantation by changing the endometrial receptivity.
Clinical diagnosis of endometriosis is based on the presence of pelvic pain that can present as excessive menstrual pain, pain during intercourse and pain that’s radiating which is dull and sometimes deep and aching. It may radiate to the thighs and legs or present with rectal pressure. Rarely it brings nausea and vomiting as well. Although severity of the disease is thought to correlate with symptoms to a certain degree, patients with advanced disease may not have any symptoms at all, while those with mild disease may have excruciating pain.
Physical examination may reveal certain findings that may suggest the presence of the disease, but generally endometriosis is not reliable and diagnostic. In most cases, the diagnosis of endometriosis is made by exclusion of other causes of pelvic pain. Surgical diagnosis is the gold standard which can include simply the observation of the lesions tha