Endometriosis can cause terrible pain, and adhesions which can stick organs together, possibly causing infertility in some women.

The Thyroid

This gald can have an effect upon fertility; and lower than normal thyroid hormone level (hypothyroid) cause infertility in both men and women.

Why is my Fertility threatened?

How many infertile couples do you know? One? Maybe Two? The rate of infertility among couples preproductive age in England and the USA is an amazing 15 to 20 per cent, about 1 in every 5 couples (so your not alone). More than 2.4 million people in America alone have been robbed of the opportunity to conceive and have a family. It had been estimated that 30 per cent of infertile couples may be infertile as a result of Endometriosis. Infertility is a mojor health issue, often due to an ilness, yet it receives very little attention from society or from Parliament and Congress. Fortunatley over 65 per cent of these infertlile couples can be helped by drugs and surgery to achieve a pregnancy. Though help is available for the couple struggling with their fertility. By contrast, IVF only has a 10 per cent success rate in Endometriosis patients.
Endometriosis is a complex disease that appears to have several different machanisms through which it may trigger infertility. It is not clear if one or more of these mechanisms is the cause of the infertility associated with Endometriosis, but Endometriosis implants have several different effects on the reproductive system.

Abdominal Ahesions and Infertility.

As the Endometriosis implants grow and develope in the abdomen, where they do not belong, the body tries to surround them with fibrous connective tissue (scar tissue). The body does this in an attempt to isolate the implants and prevent them from doing harm. Adhesions can also be formed during surgery when abdominal tissue is traumatized. This fibrous tisse develops like moss growing on a stone and dbehaves like a Band-Aid on a wound.
These fibrous growths also have the effect of making the implants stick to adjacent tissue. Remember that blood is sticky and internal bleeding from the implant also forms adhesions, such that an implant may be stuck to several different tissues like a cats's cradle, as if we placed some very sticky glue-like gum in the abdomen and several organs become sruck to each other by the very sticky strands. For example, an Endometriosis implant on the top of the uterus may cause the ovary and small intestine to become attached at the site of the implant. If the adhesions pinch off the fallopian tube or if they cause blockage to the opening of the fallopian tube, they could abstruct the union of egg and sperm and prevent fertilization and conception, or cause an ectopic pregnancy, if the embryo can't travel to the womb. This type of obstruction can be easily diagnosed and surgically corrected.
However, this does not explain how patients with just a few implants and no adhesions can become infertile. Adhesions can also cause pain, as internal organs which normally slip and slide are firmly glued together. For Example, if the bowel is stuck to a tender, painful ovary, flatulence could cause pain.

Secretions from Endometriotic implants.

As we have already seen, the Endometriosis within thw womb is a dynamic tissue that secretesa wide variety of nutrients and hormones required for normal conception. The Endometriosis implants also secrete these same substances, but instead of depositing them into the lumen (centre) of the womb as normal, the implants release their chemical secretions into the abdominal cavity. Some of these substances, which are effect strong hormones could interfere with fertility.

Prostaglandins

One major group of hormones secreted by th enormal endometrium is that of the prostaglandins. Prostaglandins are oil-based hormones found in nearly all the tissues of the body and are reguired for many bodily processes, including several stages of the menstrual cycle and pregnancy. Prostaglandins are required for ovulation, regression of the corpus luteum (i.e., ending the monthly mestrual cycle), sperm motility, immune interaction, contraction of the uterus at birth and menstrual cramps. Endometriotic implants and the endometrium of the uterus are the richest source of prostaglandin production in the body.
However, the problem with Endometriotic implants is two-fold:
1 Prostaglandins are released into the abdomen instead of inside the womb.
2 Prostaglandins release by the implants seems to be out of phase with their release by the uterus. Prostaglandins are produced at the wrong time sending the wrong message.
For instance, there is a normal surge in prostaglandin F production at the end of the menstrual cycle, causing the effect of the copus luteum of the ovary to die down and sidnalling the start of a newmenstrual cycle. The endometriotic implants produce their prostaglandin surge several days after that of the womd lining. This may be one of the main causes of very early miscarrage. If a women is a few days pregnant then the implants-produce prostaglandin F would wrongly tell the ovary to start a new menstrual cycle, causing the womb lining with the implanted edd to be slughed off - an early miscarrage. Prostaglandins are messages and like all messengers they sometimes get it wrong.
Prostaglandins also play an important role in the contractions of womb and Fallopian tubes. During the normal menstrual cycle the gentle contraction of the womb and Fallopian tube aid the movement of egg and sperm to the outer third of the Fallopian tube where fertilization occurs. High concentrations of endomertriotic implants may prevent fertilization. An excess of PGF2 and PGE2 could cause contractions that are too strong and expel the egg too quickly.

Abnormal Ovulation

The monthly maturation of egg and the process of ovulation may be altered in the patient with Endomtriosis: 'Women with Endometriosis have been shown to have smaller, but mny more, follicles maturing at the time of ovulation than controls'. This suggests that the chemical secretions from Endometriosis implants hamper the ability of the ovary to respond correctly to the message from the pituitary hormones.
Under the influence of the pituitary luteinizing hormone, the follicular wall of the ovary close to the Fallopian tube thins out ruptures. Endometriosis may prevent the completion of this ovulatory process. This inability to ovulat is called 'luteinized unruptured follicle syndrome' (LUF). In LUF syndrome, women have the normal sequence of endocrine events and a normal menstrual period, but their ovaries do not release any eggs. This syndrome is difficult to diagnose since from all external measurements (hormone concentrations and menstrual flow), nothing appears to be wrong. As the egg is but a single cell and the ovary wall repairs itself almost immediately after ovulation, the absence of ovulation usually goes unnoticed. However, some researchers have tried meticulously to check for ovulation with laparoscopic examination of the ovary at the presumed time of ovulation. They found the incidence of signs of ovulation wa slower in endometriosis patients that in fertile control patients. The development of the egg within the ovary is not yet known, but it is suggested that implants secrections, such as prostaglandins and excess natural oestrogens or even oestrogens from outside the bosy (xeno-oestrogens), are damaging to conception.

Impaired fertilization

In addition to an alteration in follicular development and ovulation, the actual quality of the egg in a women with Endometriosis may be different. Various in vitro fertilization (IVF) programmes have observed that th epresence of Endometriosis in the abdomen, and especially in the ovary, adversely affects the appearance of th eegg and decreases its ability to fertilize. Normally the eggs have a yellowish appearence with a smoth oatmeal texture. The eggs of the Endometriosis patient are sometimes dark brown in colour and have a granular texture. Im 1985 Wardle noted that the fertilization rate of eggs from Endometriosis patients was significantly lower than in patients who had unexplained infertility or blocked Fallopian tubes. Again, this could be explained by the chemical secretions from the endometriotic omplants which surround the ovary. Certainly it would seem that from observation, women who have ovarian cycts are present and improves after they have been removed. More reasearch is needed to look at this phenomenon. But it implies that woem with Endometriosis stand a better chance with ART techniques when their health has been improved.

Early Miscarrage

The most common time for a miscarrage to accur is during the first three months (trimester) of pregnancy. At the time, the embryo is developing into a fetus and is undergoing truly amazing and dramatic changes, including the formation of most of its internal organs. This is a critical period of development that requires an appropriate nutrient-rich enviroment, a healthy placenta and a very delicate balance between the various hormones of pregnancy. It has been surggested that women with Endometriosis have a greater chance of miscarrage than women with other types of reproductive dyfunction: 'Miscarrage rates as high as 46 per cent have been reported in the scientific literature'. This area is currently being examined by other researchers who have not seen as dramatic an increase in the miscarrage rate of Endometriosis patients. A hgh miscarrage rate among women with Endometriosis would offer another explanation for Endometriosis-associated infertility.
However, the real enigma of a first trimester miscarrage is that if it occurs during the first six weeks of pregnancy , there is a good chance that you may not even be aware that you are pregnant. You may think your period is late. It is very difficult to determine pregnancy rates in normal healthy women and in Endometriosis patients. In fact, this lack of pregnancy information is one of the main reasons for the confusion in the scientific literature.
Regardless of whether or not there is a high miscarrage rate in Endometriosis patients, it is imperative that you eat the right sort of nutrient-rich food to try to ensure the maintenance of your pregnancy. Nutrition in both parents even before pregnancy has a profound effect on the state f the egg and sperm, as well as on the nature of the secretions within the peritoneal cavity. Your choice of foods, particularly fats and ols, may be a crucial factor as these affect the production of prostaglandins, cell membranes, steroid hormones, and neurotransmitters etc.
Though, there are many preproductive problems associated with Endometriosis cause infertility. However, 40-60 per cent of women with Endometriosis do appear to become pregnant. There are many positive ways that we can successfully attempt to correct the problem of infertility.

Ferility and the Alert Immune System

'The leading question we should be asking here is whether or not the presence of antibodies can cause infertility and erly miscarrage , by interfering with implantation.
In order to achieve pregnancy, sperm has to enter the body. This sperm can be judges as 'alien' by a women's immune cells, because it is 'non-self'. If pregnancy is achieved, the women's immune system had to adapt to the presence of 'alien' tissue growing inside her for nine months. However, there must be some mechanisum which tells the female immune system that this alien tissue is not a danger, in order to avoid damage to the embryo. Perhaps when the immune system is malfunctioning in Endometriosis, this mechanism fails and causes an immune attack on the embryo and sperm, though leading to infertility. Correcting or strengthening the immune system may help to achieve fertility.
Scientists at University College London have discovered a protein (iscollin) inside sperm which is released as egg and sperm fuse, and start a chain reaction that causes the embryo to form.. Chemical interaction trigger calcium deposits inside the egg to vibrate and interactions trigger calcium deposit inside the egg to vibrate and begin the cell-splitting process that leads to formation of the embryo. Defective sperm or egg could not begin chain reaction. This exciting area may lead to more research into egg quality in women with Endometriosis.

Coping with Infertility.