Endometriosis is common, and many of us do not know we have it. I always had painful periods, and for that, my doctor put me on oral contraceptives. That helped a lot, as it does for most women, but it does not stop the damage that endometriosis can cause, as I found out many years later.

Endometriosis is displaced endometrial tissue. It can be anywhere in the body, but most commonly it is attached to the fallopian tubes, the ovaries, and the abdominal walls. It can distort the fallopian tubes so that they can't effectively pick up a released egg, or it can even block a tube. It can imbed on and in the ovary. When it is inside an ovary, it is an endometrioma.

If a fallopian tube's function is compromised, then it is obvious how that can lower fertility. But just the presence of endometriosis somehow affects fertility, and nobody is sure why, just as nobody is sure how it happens in the first place.

Some researchers suggest that high estrogen levels are a cause. The absolute cure for endometriosis is menopause. Other treatments, such as laproscopic surgery to remove endometrial implants, often provide temporary relief, but the endometriosis grows back.

Typically, you only find out you have endometriosis if you have a lot of pelvic pain and your doctor does laproscopy to find out the cause. Or if you are trying to conceive without success and you go through all the testing procedures, it is uncovered then. It can be a devastating blow!

As a reproductive endocrinologist told me, though, it is not the worst diagnosis you can have. IVF is an effective bypass for endometriosis. Other than the anatomical problems that the implants can cause, fertility is typically good. Women with endometriosis stimulate well and get pregnant at very good rates.

The wife of a friend of mine had severe, painful endometriosis. She had one child naturally, but they just were not successful when they wanted another. At the age of 38, she went through IVF. Her doctor was only able to retrieve four eggs from one ovary because the endometriosis was so bad on the other ovary. They were naturally disappointed with that news. However, she got pregnant and had twin boys on her first IVF attempt. Her fertility was just fine--the anatomy was what hindered them.

If you have difficult, painful periods, talk to your doctor about the possibility that you have endometriosis. If you do, at least you will know that you may very well need help conceiving when you want to do so. Perhaps you will be a good candidate for surgery to remove your endometrial implants. The key is to know your situation and your options sooner rather than later. And even though the cause is not clear, if you do have endometriosis, eliminate any exogenous sources of estrogen from your environment and your diet.