Endometriosis Update

Endometriosis is a disorder which is caused by the reflux of menstrual tissue through the fallopian tubes which subsequently implants primarily inside the abdominal cavity. This disease typically causes severe pelvic pain which tends to peak around the time of the menstrual cycle, alterations in bowel and bladder function, and pain with intercourse.

In addition, endometriosis has classically been associated with infertility. Interestingly enough, a large percentage of patients with infertility due to endometriosis do not suffer from significant painful symptoms. 

There are several mechanisms by which infertility can be caused by endometriosis.  The first is due to scar tissue (adhesions) and distortion of the pelvic anatomy as a result of the intense inflammatory reaction caused by this disease. 

The second, which is perhaps the best explanation for patients who do not have a significant amount of adhesions has to do with substances which are released in the abdominal cavity in women with endometriosis which can inhibit fertilization and embryo development.

The third stems from recent studies which have shown that patients with endometriosis may suffer from a deficiency of certain proteins within the uterine cavity which play a major role in enhancing  implantation of the embryo.

Although symptoms may be suggestive of this disease, unfortunately the only way in which endometriosis can be diagnosed is through a minimally invasive surgical technique called laparoscopy. 

At the same time as diagnosis, the disease can be treated with the use of small scissors or advanced laser technology in a minimally invasive way. Conception rates have been shown to be significantly elevated after surgical eradication of this disease.

In addition, women with endometriosis may also benefit from the use of controlled ovarian hyperstimulation techniques and, even more successfully, with the aid of in vitro fertilization. During IVF, the inhospitable environment within the abdominal cavity can be bypassed to enhance fertilization, embryo development and implantation.

Dr. Eric Surrey of the Colorado Center for Reproductive Medicine is an internationally recognized expert on the subject of endometriosis as is pertains to infertility and pelvic pain. He has published and been invited to lecture internationally on these subjects. He is President-Elect of the Society of Reproductive Surgeons and a professional member of the Endometriosis Association and the World Endometriosis Society. His research endeavors have included work on the  basic origins of this disease as well as perfecting the medical and surgical management of endometriosis. Perhaps most exciting has been recent work focusing on means of enhancing success rates with assisted reproductive technologies in infertile endometriosis patients. His work has received prize-winning recognition from the American Society for Reproductive Medicine.  

An ongoing study is evaluating the role of medical therapies for symptomatic endometriosis in improving in vitro fertilization success rates. A specific marker within the uterine lining may help to predict which patients will respond to this form of therapy.

CCRM is currently enrolling patients in a recently initiated study which is focused on efforts to improve pregnancy and embryo implantation rates in women with endometriosis who are candidates for in vitro fertilization. We are evaluating the possibility that pregnancy rates may be improved in these women after they are pretreated with one of the standard medical therapies for the painful symptoms associated with this disease: a long-acting form of a type of drug called a GnRH agonist. These medicines are approved for the treatment of the painful symptoms of endometriosis, but had not been shown to improve spontaneous pregnancy rates in infertile couples with endometriosis.

However, recent evidence would suggest that this medication may suppress the disease sufficiently so that pregnancy rates would be dramatically improved when in vitro fertilization is performed before the disease has a chance to recur.

Candidates for this study include patients with surgically documented evidence of endometriosis who are candidates for in vitro fertilization. After a small biopsy of the uterine lining is performed to evaluate the presence of a marker for implantation, which we are currently investigating, patients are randomized by computer to receive a course of the GnRH agonist for three months prior to their IVF cycle, or to receive standard therapy.

Patients who are enrolled in this study will receive the GnRH agonist at no cost and will also receive a reduction in the cost of their IVF cycle. We are now enrolling patients who are candidates.  Please contact our Research Coordinator, Susie Lietz, at 303-788-8300, or schedule a new patient appointment with Dr. Eric Surrey, our endometriosis expert at 303-788-8300, ext. 5.