[ESTHER EISENBERG, M.D.] Endometriosis is a condition that can cause infertility.

And so, to that extent, it is one of the areas that we work in.

We fund research in that area if it involves infertility.

And also, as part of the Reproductive Medicine Network, we are developing clinical trial

protocols that involve women who have infertility and endometriosis, and also we are currently

developing a protocol to identify, potentially, a noninvasive diagnostic marker of endometriosis.

We don’t really know what causes it, but we know that it may be related to the fact

that when women menstruate, some of their uterine lining, which is part of the menstrual

tissue that is shed, sometimes flows backward through the fallopian tubes and deposits in

the—what we call peritoneal cavity.

When the various theories of what causes endometriosis were first proposed, the theory of

retrograde menstruation was the one that had the most credence.

And with the advent of laparoscopy and being able to observe a woman during her menstrual

cycle, it was identified that the majority of women have retrograde menstruation.

So then the question came up: Why do some women develop endometriosis and others not?

And it’s thought that these women may have some hormonal or immunologic reasons so they

may react differently to the tissue fragments that get deposited in the pelvic cavity that

enable those to implant, whereas other women are able to clear them more effectively.

In women with endometriosis, during their menstrual cycle, this tissue has a life of

its own and can bleed and can cause inflammatory reactions and can cause scar tissue.

And then those things can lead to infertility and pelvic pain and some of the symptoms that

are related to endometriosis.

Women with endometriosis often do have painful menstrual periods.

Pain with intercourse is a symptom that many women will experience.

And one of the problems with endometriosis is that it may go undiagnosed for quite a

while and in many women will only be diagnosed once they experience infertility or if they

are having severe pelvic pain.

Recently a study was completed that—the goal was to identify a way of diagnosing endometriosis

that didn’t involve a surgical diagnosis.

So this would involve obtaining tissue from the uterine lining and then looking at certain

genetic markers in that tissue, and if there is a specific group of markers—so almost

like a fingerprint of endometriosis— then that person could be diagnosed.

Now this has been looked at in a small group of endometrial biopsy samples and needs to

be validated in a larger sample.

I think that endometriosis is such a broad field.

I think that we need to chip at it in many directions.

It’s almost like having a large jigsaw puzzle, and you have certain parts of it where you

have put together the different shapes, but you still don’t know what the whole picture is.

And so I think we just need to keep working at it, piece by piece, so that we have a better understanding.