Another item in “The Obstetrician & Gynaecologist” discusses endometriosis and subfertility (August, 2011). There is no doubt that there is a relationsip between endo and fertilty – but it does not look like a uniform relationship. Clearly women with grade 4 endometriosis have substantial difficulties to overcome though the relationship between grade 1 endometriosis and fertility is less clear. Some women have problems; others do not.
In advanced endometriosis the Fallopian tubes may be swollen, blocked or distorted by adhesions. Many of these uteri show abnormal nerves meaning that the uteri do not contract in a co-ordinated fashion – from top to bottom. They contract in an inco-ordinate fashion – that may prevent trasnport of egg and sperm, or, prevent implantation of the embryo. Similar changes may take place in the Fallopian tubes where little is known about their nerve supply. A study from Germany, using dynamic magnetic resonanace imaging studies, showed inco-ordinate activity of the uterus and Fallopian tubes in women with endometriosis (Kissler, 2008). Preliminary studies from China show direct evidence of abnormal nerves in the Fallopian tubes in some circumstances. This study looked at ectopic pregnancy though further studies of Fallopian tubes in women with endo an chron ic pelvic pain will follow.