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Endometriosis / Infertility

What is endometriosis?

Endometriosis is a condition whereby the normal endometrial tissue that lines the uterus is in an abnormal location, i.e., in the pelvis and/or abdomen.  There are multiple theories as to the cause of endometriosis.  The most widely held is the idea of retrograde menstruation, whereby menstrual efflux instead of draining through the cervix and vagina backs up, goes through the tube and implants on the surfaces (peritoneum) of the pelvis and abdomen.  This tissue grows and bleeds just like the tissue in the uterus.  Bleeding is looked at as an injury, i.e., an abnormal condition, whereby the body tries to heal itself, causing scarring.  Scarring can distort or damage the tubes, ovaries and other pelvic/abdominal organs.  Endometriosis if it is in areas where there are nerves can cause pain.  The pain with endometriosis typically occurs just prior to and with menses and generally improves after bleeding.

How common is endometriosis?

Endometriosis is reported in 5-10% of menstruating women.  Amongst infertility patients this number increases dramatically.  If an individual has a first degree relative with endometriosis the incidence of endometriosis is approximately seven times greater.

How is endometriosis diagnosed?

Endometriosis is diagnosed primarily via laparoscopy. Laparoscopy involves introducing a small diameter scope through the umbilicus using CO2 to distend the pelvic/abdominal cavity.  Using additional laparoscopic instruments endometriosis can be removed.  There are various techniques to remove endometriosis depending on size, depth and location of the lesions.  In general it is possible to remove lower degrees of endometriosis, i.e., stage 1, 2 and early stage 3 disease.  Advanced stage 3 and stage 4 disease is often diffusely distributed throughout the pelvis and abdomen and may not be able to be fully removed.  In cases of advanced endometriosis where fertility is desired, often IVF is the preferred option to “bypass” the disease.  It is controversial whether endometriosis affects IVF success rates and to what extent.  At the Florida Institute for Reproductive Medicine we have not seen any appreciable decrease in pregnancy rates.  A particularly troubling form of endometriosis is when it organizes and grows in the ovary (an endometrioma) destroying the source of eggs.  Sometimes it is appropriate to remove endometriomas, other times to leave them alone – whenever surgery is performed there is the potential to damage healthy egg producing tissue.

Treatment for endometriosis for non-fertility patients.

If an individual has endometriosis and infertility is not a concern often suppressive medication in the form of a birth control pill or shots of long acting progesterone or GnRH agonist can be used to “turn off” the menstrual cycle.  In general anything that prevents the menstrual cycle will improve pain.  Long acting progesterone and/or GnRH agonist can only be used for short periods of time as their suppressive effects can affect bone health.  For long term suppressive care, a progestin dominant birth control pill, used in a continuous manner is the treatment of choice.  Once childbearing has been resolved, if pain is still significant with suppressive therapy, hysterectomy with unilateral or bilateral removal of an ovary(s) with aggressive resection of disease offers the best chance for long-term pain relief.

Care, Cost, Convenience

Infertility is a 7 day a week process. The Downtown Jacksonville center is open 7 days a week. Jacksonville, Daytona and Tallahassee office hours are 7am – 4pm.
JACKSONVILLE

Jacksonville Downtown »
836 Prudential Dr, Ste 902
Jacksonville, FL 32207
904-399-5620

Jacksonville South »
14540 Old St. Augustine Rd, Ste 2503
Jacksonville, FL 32258
904-262-5992

Jacksonville Beach »
1577 Roberts Dr, Ste 220
Jacksonville Beach, FL 32250
904-270-1135

DAYTONA BEACH

Daytona Beach, FL »
415 N Clyde Morris Blvd
Daytona Beach, FL 32114
386-254-8211

TALLAHASSEE, FL

Tallahassee Memorial Hospital »
1401 Centerville Road, Suite 202
Tallahassee, FL 32308
1-800-556-5620

Tallahassee, FL »
2623 Centennial Blvd., Suite 101
Tallahassee, FL 32308
1-800-556-5620

SOUTH GEORGIA

Valdosta, GA »
220 Northside Drive
Valdosta, GA 31602
1-800-556-5620

Thomasville, GA »
918 South Broad Street
Thomasville, GA
1-800-556-5620

Brunswick, GA »
3025 Shrine Road, Suite 190
Brunswick, GA 31520
1-800-556-5620

Florida Institute for Reproductive Medicine proudly serving patients in North Florida and South Georgia including Savannah, Columbus, Jacksonville, Jacksonville Beach, Orange Park, St. Marys, Palm Coast, St. Augustine, Palatka, Lake City, Tallahassee, Daytona, Ponte Vedra, Gainesville, Orlando, Melbourne, Ormond Beach, New Smyrna, Port Orange, Brunswick, St. Simons Island, Thomasville, Tifton, Albany, Brunswick, Valdosta and Dothan Alabama.

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