When some of the tissue that lines the uterus (endometrium) goes out the tubes during a period, endometriosis can occur. This can cause infertility, painful menstrual periods, pain with bowel movements, urination or intercourse. The damage from this can result in blocked tubes, scar tissue or ovarian cysts full of endometrial fluid (endometriomas). Endometriosis can involve the large intestine or bladder as well. Medication such as Lupron can be used to decrease the pain of endometriosis but it delays attempting pregnancy. Surgical removal of the disease at laparoscopy by an experienced Reproductive Endocrinologist can improve both pain and fertility potential. Some patients require IVF to obtain a pregnancy. Autoimmune factors may be evaluated as well.