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Endometriosis may well be the scourge of the modern woman bent on pursuing a career by delaying her child bearing. It is an enigmatic disease plaguing a fraction, albeit sizeable number, of older adult women. Those, however, with a very strong family history or with concomitant congenital problems may have it as early as young adulthood or in their adolescent years.
 
It is a disease in which refluxed cells from the endometrium, the lining of the uterus, implant into the pelvic cavity and all structures therein. The cells, while mostly from passing out with the flow of menstruation, also pass backward, through the fallopian tubes. Though most women have this reflux, not all will develop endometriosis. Women who have some amount of impaired immunologic functions have a decreased ability to “clean-up” the refluxed cells. The cells implant at the back of the uterus, into the ovaries and sometimes into the intestines and ureters (tubes draining the kidneys of urine to the bladder). The more we delay child bearing, the more menstrual cycles we have, therefore, increasing the number of refluxed cells into our pelvis.

 

‘The more we delay child bearing, the more menstrual cycles we have, increasing the number of refluxed cells into our pelvis’

 
The condition may cause pelvic pain if it infiltrates the nerves. Cysts, or benign masses of the ovaries, may develop. It may result in compression, sometimes obstruction of the intestines and ureters. It also causes adhesions of many of the contents of the pelvis and may disturb the function of the fallopian tube in the transport of the egg. It is in this regard that fertility is impaired. Implants of endometriosis, it is hypothesized, may also release toxic substances that may decrease egg quality and affect early embryo survival.
 
It is in these last two aspects that fertility is impaired. Among those with endometriosis, the impact on fertility is variable. Aside from a scoring system specialists use to document the severity of endometriosis, there are many other factors to be considered that could hamper a woman’s ability to conceive.
 
A woman with a long history of painful menstruation, or who has already been diagnosed with endometriosis, should seek the assistance of fertility experts to optimize their chances of conceiving. This should be done as early as possible because—and this is common knowledge our biological clock is relentlessly ticking.