The lining of the uterus when it is present outside the uterus like in the ovary, over the fallopian tubes or inside the abdominal cavity, it is called as endometriosis. That is endometrial lining being present at abnormal places. But this lining responds like the regular endometrium with the monthly cycles. So it bleeds wherever the endometrial ling is present. When it is there in the ovary it could form a cyst. Cyst whch is filled with blood, in the long run it becomes chocolate cyst or on the fallopian tube it could produce puckering or the fallopian tube or scarring of the fallopian tube, altering the tubo ovarian relation. How does this affect the fertility? It is common entity affecting 10 to 15% of women. Again there are grades of endometriosis. It could be very mild where the patient has no symptoms at all or it could be very severe where there could be big chocolate cysts and the ovaries, tubes and the uterus is also stuck to each other and the patient is having severe symptoms. So these are mild to sever stages of endometriosis. So this can cause painful menstruation, low back ache, heavy menstrual flow or pain dung intercourse, difficulty in conceiving. All this will require to further investigate if there is any evidence of endometriosis. Milder variety will only be picked up on laparoscopy, where we see small powder burn spots on the peritoneum which are to be ablated. Very rarely we see the entire tubes ad ovary have become a mass where teh entire tubo ovarian relationship is destroyed. Hence the oocyte pickup that happens around the time of ovulation and the patient is not able to conceive. The other ways in which endometriosis causes infertility is it causing painful during intercourse or it can also forma cyst in the ovary. When it forms a cyst in the ovary it will not allow the regular follicles to grow and fetch egg. Even if the egg is related it will be of poor quality because of the inflammatory mediators released and the quality of the eggs will so be poor and will not result in pregnancy but it doesn’t mean that with endometriosis you are not able to conceive spontaneously. There are lot of spontaneous pregnancies reported and let of them do conceive naturally but again depends on the severity and the nature of the disease.

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