Unraveling Endometriosis: Impacts on Fertility and Beyond – ARC Summit

I’ll now discuss endometriosis, a condition that can alter the environment in the fallopian tubes where egg and sperm meet. Endometriosis involves the presence of endometrial glands and stroma outside the uterine cavity. Typically, during menstruation, while 90 to 95% of menstrual blood exits through the vagina, about 3 to 5% can reflux back through the fallopian tubes into the pelvic cavity. This refluxed menstrual blood may attach to and derive blood supply from various pelvic organs such as the ovaries, fallopian tubes, and the peritoneal surface.

Under normal circumstances, the immune system clears away this stray endometrial tissue. However, if the immune system is compromised or if there is an unusually high amount of refluxed blood, the body may not keep up, leading to the accumulation of endometrial glands and stroma within the pelvic cavity, which is clinically recognized as endometriosis. Although all women may experience some degree of retrograde menstruation, it is typically the immune response that prevents the development of endometriosis.

For example, I once had a patient who developed an endometrioma following chemotherapy. Before her treatment, her pelvic region was normal, but the chemotherapy weakened her immune system. This disruption allowed menstrual blood to accumulate and form an endometrioma in her ovary about six months after completing her chemotherapy. This case illustrates how changes in the immune system can exacerbate the effects of endometriosis.