Different stages and endometriosis, I will say, it well depends on your symptoms itself, it’s not about the stage because we may accidentally find it: one lady, she has three children and she came for tubal ligation to close her tubes and we are there and accidentally we found endometriosis, severe endometriosis and she had no problem with infertility and she was staged on our classification stage IV or deep infiltrating endometriosis. On the other hand, you may find very mild endometriosis and very mild endometriosis symptoms on the keyhole surgery on the laparoscopy and she has infertility and she is not complaining about pain. So endometriosis incidence in the fertility population it’s 40%. So 40% it’s quite a high figure if you are not aware of endometriosis. So this is a huge problem because you will miss a huge number of women who need treatment. So the stage will not matter exactly about the symptoms of infertility or pain but it may matter if we know this stage by just adjusting the protocol of IVF or a protocol for treating this infertility.
Endometriosis can be mild, moderate or severe or the other way of classifying the disease is stage I, II, III or IV depending on the severity of endometriosis which is usually classified when we put the camera inside the tummy and actually visualize the disease and then we categorize. There is an American Fertility Society criteria for that.
Interestingly, in this disease which is also called a disease of theories because there is no clear-cut explanation, the extent of the problem is not related with the extent of the symptoms. Patient could have symptoms of pain or sub-fertility but she could have very minimal or mild endometriosis. Interestingly, she could have severe endometriosis when we classify her or stage her disease but she could achieve pregnancy on her own. The stage of the disease has got nothing to do with the actual symptoms which could be different – which is interesting in this disease.
