Endometriosis

Q. We have been trying to get pregnant and no one seems to know what’s wrong with us. My husband’s sperm count was normal and I have a normal uterus and tubes. I do notice spotting for several days before my period starts and have always had very painful periods, especially on the first day. What can we do?

A. The approach to couples with infertility includes assessment of the male (semen analysis), the fallopian tubes (HSG) and some assessment of ovulatory status. I women with painful periods, inclusion of a laparoscopy is also warranted, since up to 40% of couples we see have endometriosis diagnosed. This is a condition that is common and often overlooked. Spotting or bleeding at times other than your period is sometimes a sign of endometriosis. The presence of endometrium (lining of the womb) outside of the uterus is associated with painful menses but also infertility. Interestingly, even mild forms of this disease can cause profound infertility. The good news is that endometriosis is very treatable and most women conceive after it is diagnosed.