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Could Your Unexplained Infertility Actually Be Endometriosis?

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March 14, 2013

A diagnosis of unexplained infertility can be frustrating to say the least. You’ve tried to conceive on your own for several months and just when you think your fertility doctor is going to find the cause of your inability to get pregnant, test results come back with no known cause, or unexplained infertility.

A recent study out of Turkey suggests that women diagnosed with unexplained infertility might actually have an underlying case of endometriosis that was initially missed. The cases of six hundred women diagnosed with unexplained infertility between 1995 and 2008 were examined. Laparoscopy was performed on all 600 women during the follicular phase, in which eggs begin to grow and endometrial tissue builds up. Results indicated that 15% of participants actually had endometriosis, while another 20% suffered from pelvic adhesions, or scar tissue that can result from endometriosis. A French study, published in the European Journal of Obstetrics & Gynecology and Reproductive Biology discovered that by using laparoscopy, 72 of 114 patients initially diagnosed with unexplained infertility were identified as having endometriosis.

Rony Elias, M.D., a fertility doctor at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at Weill Cornell Medical College says this data proves that laparoscopy or robotic surgery should be reintroduced into the standard fertility workup. “The main issue is that laparoscopy or robotic surgery is not part of the workup for infertility anymore. Since IVF success rates have increased, a lot of centers opt to treat a patient with IVF rather than digging deeper to diagnose and treat the underlying cause of endometriosis,” he says.

Endometriosis cannot typically be seen on trans-vaginal ultrasound, so the best way to diagnose endometriosis is by taking a thorough medical and menstrual cycle history and using a laparoscopy to examine the presence of scar tissue. However, there are two schools of thought regarding endometriosis treatment: use laparoscopic surgery to remove scar tissue, or leave the tissue alone and use IVF to bypass scarring on the ovaries and help a patient conceive. IVF is certainly a suitable means of helping a patient with Unexplained Infertility or endometriosis to conceive, however, it does not confirm an underlying diagnosis or address the potential symptoms of endometriosis.

Dr. Elias believes that especially for younger patients with an unknown reason for their infertility, either laparoscopy or a robotic surgical technique called Davinci, are important diagnostic tools. “I believe that you can’t define someone to have unexplained infertility without checking to see if they have endometriosis,” Elias states. The Davinci procedure offers highly accurate detection of endometriosis, perhaps even greater than laparoscopy, with minimal damage to healthy tissue. Given that the symptoms of endometriosis vary on a per-patient basis and range from very mild to severe pain and bleeding, it seems minimally invasive surgery or laparoscopy could deliver diagnoses to more women with no explanation as to why they have not gotten pregnant. Results of the French study showed that 77 patients went on to conceive after laparoscopy, 35 of whom ovulated through their own fallopian tubes as opposed to using fertility treatments like IVF.


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