Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. This tissue can appear on the ovaries, fallopian tubes, peritoneum, and other pelvic organs.
This tissue reacts to hormonal changes during the menstrual cycle, causing inflammation and changes in the affected areas. Over time, endometriosis can lead to adhesions and ovarian cysts called endometriomas.
Endometriosis does not always prevent pregnancy, but in some women it may be linked to infertility. If pregnancy does not occur, it is important to understand what role the disease plays in each specific situation. Reproductive function can be affected by the stage of endometriosis, the condition of the ovaries and fallopian tubes, age, ovarian reserve, and other factors.
Because of this, treatment for infertility in endometriosis is always tailored to each person. The European Society of Human Reproduction and Embryology (ESHRE), which creates clinical guidelines for reproductive medicine, has specific recommendations for fertility and assisted reproductive technologies in endometriosis.
But does a diagnosis of endometriosis mean a woman will need IVF? Is surgery required before treatment? And when is it really time to see a fertility specialist?
How endometriosis can affect fertility
Endometriosis can affect the ability to conceive for different reasons, and these are not the same in every woman.
Endometriosis can cause adhesions, which are bands of dense tissue that can shift the position of pelvic organs. In more severe cases, these adhesions can also affect how the fallopian tubes work.
Another factor is endometriomas, which are ovarian cysts linked to endometriosis. These cysts can affect the ovaries, and surgery to remove them must be done carefully, since it can lower ovarian reserve.
Endometriosis also causes inflammation in pelvic tissues. This means its effect on fertility is not just about cysts or adhesions.
Remember, having endometriosis does not automatically mean infertility. Doctors look at your overall reproductive health, not just the diagnosis.
Can you get pregnant naturally with endometriosis?
Yes. Endometriosis does not mean a woman cannot conceive naturally. Many women become pregnant without IVF or other assisted reproductive methods.
If pregnancy does not occur, the doctor assesses the situation as a whole. Age, the condition of the ovaries and fallopian tubes, ovarian reserve, the presence of endometriomas, previous surgeries, and other possible causes of infertility are all taken into account.
A diagnosis of endometriosis alone does not decide your treatment plan. Sometimes, a doctor may suggest trying naturally, treating endometriosis first, or considering IVF, depending on your situation.
When to see a fertility specialist
Regular gynecological visits are important, even if you feel fine. Preventive check-ups can catch changes early and help start treatment if needed. At Silk Medical, you can schedule a gynecological check-up for this purpose.
If endometriosis is found during an exam, especially if there are ovarian endometriomas or other significant changes, it is best to see a fertility specialist soon. Even if you are not planning a pregnancy right now, the specialist can check your ovaries and ovarian reserve, explain how endometriosis might affect future pregnancy, and help you plan ahead if needed.
If you are already planning to get pregnant, it is even more important to see a fertility specialist. You do not have to wait the usual amount of time trying on your own. The American Society for Reproductive Medicine (ASRM) says that fertility evaluation can start right away if a woman has a condition that may affect fertility, such as known or suspected endometriosis.
Is surgery for endometriosis needed before IVF?
According to the ESHRE guidelines, routine removal of endometriomas before assisted reproductive technologies solely to improve the chance of a live birth is not recommended. Evidence of such benefit is insufficient, and surgery can reduce ovarian reserve.
However, surgery may sometimes be needed. For example, it might be considered if an endometrioma causes severe pain or makes it hard to reach follicles during egg retrieval.
The decision about surgery is made for each person, based on the size and location of the endometrioma, symptoms, ovarian reserve, age, and treatment plans.
So, if you are planning a pregnancy, it is best to talk with a fertility specialist about any possible surgery ahead of time.
When IVF is considered for endometriosis
IVF may become one of the treatment options if pregnancy does not occur naturally or if there are factors that substantially reduce the likelihood of natural conception.
The decision to proceed with IVF depends not only on the stage of endometriosis. The doctor also considers the woman’s age, ovarian reserve, the condition of the fallopian tubes, the presence of endometriomas, previous surgeries, the duration of infertility, and other possible causes.
For example, IVF may be considered when:
- There are changes in the fallopian tubes. Endometriosis and associated adhesions can disrupt tubal function. IVF allows this factor to be bypassed.
- There are additional causes of infertility. For example, a male factor is present as well and also affects the chance of natural conception.
- Previous treatment did not work. If pregnancy did not occur after other treatments, the doctor may discuss assisted reproductive technologies.
- If age or ovarian reserve makes waiting risky, the doctor will look at your reproductive outlook and help you decide how long to keep trying naturally and which treatment might be best.
Does endometriosis affect IVF outcomes?
Endometriosis is one factor doctors consider when planning IVF, but the diagnosis alone does not determine your outlook.
Age, ovarian reserve, the condition of the ovaries, the presence of endometriomas, previous surgeries, the stage of the disease and other causes of infertility all matter.
This means that two women with the same diagnosis can have very different chances and may get different recommendations.
Endometriosis does not mean IVF is off the table. Assisted reproductive technologies can help with infertility related to endometriosis, but there is no one-size-fits-all approach.
What happens at a fertility consultation
When someone has endometriosis and trouble conceiving, the doctor starts by looking at their overall reproductive health.
Attention is usually given to:
- medical history and previous pregnancies;
- the menstrual cycle and endometriosis symptoms;
- ultrasound findings;
- the condition of the ovaries and the presence of endometriomas;
- ovarian reserve;
- the condition of the uterus and fallopian tubes;
- previous surgeries and treatment;
- the partner’s reproductive health.
This approach helps find out what is really causing trouble with pregnancy, instead of giving treatment just because endometriosis is present.
It is important to check the reproductive health of both partners, since trouble conceiving can have more than one cause. This thorough approach matches ASRM recommendations for infertility evaluation.
IVF for endometriosis at Silk Medical
If endometriosis is accompanied by difficulty conceiving, a patient can have a consultation with a fertility specialist and a comprehensive reproductive health assessment.
At Silk Medical, treatment is tailored to each person, based on medical history, exam results, age, ovarian reserve, and other factors. Depending on your situation, you may be offered different IVF programs, using your own or donor eggs.
If your own eggs are not suitable for a particular treatment program, Silk Medical also offers programs with donor eggs.
Where indicated, treatment may include additional reproductive technologies, such as ICSI, cryopreservation of biological material and preimplantation genetic testing.
If you are coming to Georgia from another country, it helps to know ahead of time which exams and treatment steps you might need. You can talk about your medical history and past test results with a fertility specialist before your visit.
Key points to remember
Endometriosis does not mean you cannot get pregnant. Many women with this diagnosis conceive naturally. However, if you have endometriosis, especially with endometriomas or past ovarian surgery, it is important to check your reproductive health without delay.
Surgery isn’t always needed, and IVF isn’t always the answer. The best approach depends on your age, ovarian reserve, the condition of your ovaries and fallopian tubes, how advanced the endometriosis is, and other factors.
Talking with a fertility specialist can help you understand how endometriosis might affect your pregnancy plans and which options are best for you.
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