What is endometriosis?
Endometriosis is a painful disorder of the lining of the uterus, wherein the tissue that normally lines the inside of your uterus starts to the outside of the uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. In some rare cases, the endometriosis tissue may spread beyond pelvic organs as well. The condition is closely associated with infertility.

What are the Symptoms of endometriosis?
The symptoms associated with endometriosis include:

• Dysmenorrhea
• Painful intercourse
• Difficulty in passing stools
• Excessive bleeding
• Infertility

How is endometriosis diagnosed?
To diagnose endometriosis the woman will be required to undergo a physical examination of the uterus and the pelvis. This will help ascertain abnormalities, such as cysts on the reproductive organs or scars behind the uterus. An ultrasound will also be required to get the best view of the reproductive organs and can identify cysts associated with endometriosis. In some cases, an MRI may be required to ascertain detailed information about the location and size of endometrial implants.

Finally, a minimally invasive laparoscopic procedure may be carried out to look for signs of endometriosis and extract a tissue sample for additional symptoms.

What are the Stages/severity of endometriosis?
Endometriosis can be categorized into four stages based on the severity of the symptoms. The stages can be enumerated as below:
Stage 1: Minimal
Stage 2: Mild
Stage 3: Moderate
Stage 4: Severe
The categorization depends on how much tissue has grown and where it is, rather than just the severity of the pain. Thus, it is quite conceivable that someone in stage 4 might not experience any pain, while someone in stage 1 may be in excruciating pain.

What causes endometriosis?
The exact cause of endometriosis is yet unknown but some of the possible causes can be enumerated as:

• Revere flow of menstrual blood
• Embryonic cell transformation
• Scars caused by surgical implantation
• Disorders of the immune system
• Malfunction of peritoneal cells

How endometriosis affects fertility?
Firstly, it must be well understood that women with endometriosis will have challenges with conception but may not be exactly infertile. In most cases, women suffering from mild endometriosis to moderate endometriosis can eventually get pregnant without the need for any treatment. The exact nature of the link between infertility and endometriosis is unclear, but the severity of the condition is based on the location of the tissue. In case of severe endometriosis, the chances are likely to be affected by the changes to your anatomy. However, even with severe endometriosis, natural conception is possible, and conception can be achieved with assisted reproductive methods.

Getting pregnant with endometriosis – treatment.
Treatment for endometriosis is a twin-pronged procedure with clinical intervention and a possible surgery for extreme cases. The mode of treatment is based on the severity of symptoms and whether you wish to become pregnant in the future. For patients with endometriosis, who are trying to become pregnant, the surgery will remove the endometriosis tissue. If you have severe pain from endometriosis, you may also benefit from surgery — however, the endometriosis and pain may return eventually.

How long should someone wait until after a laparoscopy to try to conceive?
There is no specific timeframe required for a woman to stay away from trying to conceive after a laparoscopy. This will remain specific to each individual based on various factors such as the amount of tissue removed, the location, the individual age and previous infertility.

Are there any reliable statistics on chances of conceiving after successful surgery?
The chances of conception after successful surgery can be ascertained by the endometriosis fertility index (EFI); this considers infertility, the severity of the disease, issues with fallopian tubes, age, and history of pregnancy/conception.

IVF and Endometriosis
Endometriosis results in the development of abnormal cells in the lining of the uterus and outside of it, usually in the abdomen, fallopian tubes, ovaries, and ligaments supporting the uterus, causing difficulties in conception. For those suffering from endometriosis, IVF is a viable path to parenthood. In vitro fertilization works just as well for women with this diagnosis as it does for those who do not have endometriosis. Prior to the treatment the doctor will explain the chance of in vitro fertilization working for you, based on your age and hormone testing.

Endometriosis, diet, and conceiving
Endometriosis causes hormonal imbalances and weight issues amongst women – which in turn increases the difficulty of conception. A good, balanced, and nutritious diet is a prerequisite for attaining appropriate weight and trying to conceive. Specific to endometriosis, there are no additional dietary requirements or restrictions prescribed.

Endometriosis and miscarriage
Endometriosis treatment has shown no specific effect on miscarriage rates, as both women who undergo endometriosis surgery and who have not show similar rates of miscarriage and failed pregnancies. However, data also proves that women with endometriosis are at higher risk of miscarrying compared to those without.

Endometriosis and pregnancy
Complications of endometriosis during pregnancy are rare but there is an increased risk of placenta praevia (low-lying placenta), in which the placenta attaches lower down in the womb. It is also linked to ectopic pregnancy.

Endometriosis and your mental wellbeing
Mental well-being is an area where the significant impact of endometriosis has been evidenced. Given the fact that this is a lifelong condition with several symptomatic manifestations, it can have a huge effect on your mental wellbeing, which is often worsened by the fact that there are few external signs of the pain and impact.