New Jersey fertility doctor, Jane Miller, M.D. is an expert in diagnosing and treating endometriosis.
The term, endometriosis, is a condition in which the endometrium is where it shouldn’t be. The endometrium is the uterine lining. In a regular, monthly menstrual cycle the ovarian hormones, estrogen and progesterone, prepare the endometrium for the implantation of an embryo. If egg and sperm have not “met” in the fallopian tube and there is no embryo to implant, the endometrium sloughs off in the woman’s period. But sometimes the endometrial tissue ends up inside the pelvis and implants or burrows in to the ovaries, ligaments, peritoneum (the tissue that lines the pelvis) and even the bowel and bladder creating endometriosis. The consequences of this can be a painful luteal phase – the post-ovulatory half of the cycle , dysmenorrhea – painful periods, and infertility.
How does the endometrial tissue get into the pelvis?
There are eight plausible theories as to the etiology of endometriosis but the most popular one is Sampson’s theory: that of retrograde flow of endometrial tissue backwards through the fallopian tubes. When a woman has a period there is always some tissue that does not leave the uterus via the cervix in the usual way. Everyone who menstruates will have some tissue travel “backwards” through the fallopian tubes. The mystery is why this tissue implants in the pelvises of some women causing endometriosis but not in others.
Endometriosis in the pelvis causes lesions, or spots on the ovaries, ligaments, and peritoneal surfaces, and often adhesions or scars as well. The lesions cause pelvic pain which can be so disabling that intercourse as well as periods are “dreaded events”. Pain may also arise from pelvic adhesions which may pull an ovary or tube or even the bowel out of its normal anatomic position. Often, however, a woman may have thick adhesions which do not cause her any pain at all.
How does endometriosis cause infertility?
Endometriosis can cause infertility in numerous ways. Adhesions may produce a mechanical impediment to normal tubal function. The fallopian tubes must be flexible and adhesion-free to be able to pick up ovulated eggs so that they can travel up to the midportion of the tubes where they can be fertilized. Endometriosis lesions secrete chemical factors that can prevent both fertilization and embryo implantation. Endometriomas, which are ovarian cysts that contain endometriosis fluid, can be toxic to the eggs that are situated near them. These eggs, if fertilized, may have poor developmental potential.
New Jersey fertility doctor, Jane Miller MD has more than 25 years’ experience diagnosing and treating endometriosis. Treatments may include minimally invasive laparoscopic surgery and/or medical management. These treatments are part of a patient’s overall plan to get pregnant. Once the treatment is completed Dr. Miller continues to work with the patient until she has a healthy, ongoing pregnancy.
Watch Dr. Jane Miller discuss endometriosis and infertility
Please contact our New Jersey Fertility Center to schedule an appointment.