Endometriosis Scar Tissue on Ovary &Infertility
How Ovarian Endometriosis Cysts Affect Fertility and Pregnancy
Oct 22, 2009
Ovarian endometriosis is the most common type of endometriosis, probably because of the ovary's proximity to the uterus. Eggs mature in and release from the ovary, so at least one functioning ovary is essential for getting pregnant (there are two ovaries, one on each side of the uterus).
Endometrial tissue behaves the same way when it's implanted itself around the ovaries as it does when it's at home in the womb. It reacts to hormonal changes during the menstrual cycle by thickening during the first half of the cycle, as estrogen levels rise, and sloughing off as hormone levels drop and you get your period.
When endometriosis bleeds, the sloughed tissue doesn't have an easy exit route like it does in the uterus, where it escapes through the cervix. Instead, endometriosis implants accumulate around the ovary and cause cumulative damage over time. Interference with the ovary's ability to mature and release a mature egg can cause infertility from endometriosis.
Endometriosis and Scar Tissue on Ovaries
Ovarian endometriosis damages the ovaries by causing scar tissue, also known as adhesions. Scar tissue can damage the ovaries in a number of ways:
- The entire ovary can become encased in scar tissue, so the egg can't be released.
- The ovary can stick to nearby structures, such as the intestines or the fallopian tubes, and the egg can't reach the fallopian tube.
- The monthly growth and bleeding cycle of endometrial implants causes irritation, inflammation and a release of toxins that produce scar tissue around the ovary.
Scar tissue formation isn't the only way endometriosis damages ovaries. Endometriomas (also known as chocolate cysts), cysts made up of old blood and debris, may grow after endometriosis infiltrates the ovary. These can grow large enough to destroy ovarian tissue. Endometriomas can be drained or surgically removed.
Laparoscopic surgery for endometriosis removes scar tissue around the ovary, but can also damage a part of the ovary, or remove some functioning tissue. While this is a risk of any surgery, the risks of laparoscopic surgery for endometriosis are usually outweighed by the benefits in preserving ovarian tissue so pregnancy can be achieved.
Treating Endometriosis on the Ovary to Prevent Infertility
Whether or not treating ovarian endometriosis is necessary depends on the stage of endometriosis found. Mild endometriosis generally doesn't need treatment; most studies show the chances of pregnancy don't improve with medical intervention in mild endometriosis.
Moderate endometriosis may be treated with medications called gonadoptropins, which increase the number of eggs produced each cycle, and/ or by medications to help an egg release from the ovary. Severe ovarian endometriosis may require surgery to remove endometrial implants and scar tissue.
One problem with having laparoscopic surgery for endometriosis is that surgery causes more scar tissue to form. If endometriosis is severe, in vitro fertilization (IVF) may be necessary to get pregnant, because an egg can be removed surgically from the ovary and implanted directly into the uterus after fertilization.
Ovarian Endometriosis and Pregnancy Rates
Having ovarian endometriosis doesn't mean it's impossible to get pregnant; most cases of endometriosis are mild, and a woman might not even know she has endometriosis. Endometriosis definitely does decrease the chances of pregnancy in women with moderate or severe endometriosis, and should be treated by a doctor who specializes in endometriosis and infertility.
For women undergoing IVF dealing with infertility from endometriosis, study results are mixed; some studies, like a large study of almost 900 IVF patients conducted by The Center for Reproductive Medicine and Infertility, Weill College of Cornell University, New York, showed that the stage of disease had no significant effect on outcome. Another review of a number of research studies suggested that women with endometriosis were one third less likely to get pregnant using IVF than women with tubal damage.
Coping With Endometriosis Scar Tissue on Ovary
Ovarian endometriosis can cause serious challenges to getting pregnant. But clinical trials on treating endometriosis are being done all the time, and an infertility specialist will have the most up to date information to help you get pregnant. Reading information on endometriosis can help women dealing with endometriosis and infertility get pregnant. Ovarian endometriosis won't resolve on its own, and usually worsens until menopause, when monthly hormone changes lessen so treating it early helps preserve fertility.
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