Endometriosis is a frequent finding in patients with infertility. How can
you increase the chance for pregnancy if you have
endometriosis? What should you avoid? Watch this episode and I will explain
What is endometriosis? Endometriosis occurs when the tissue which is normally found inside
of the uterine cavity, grows outside of the uterus in the abdomen. Endometriosis can grow
anywhere. It is often found on the outside of the uterus, on the fallopian tubes, the ovaries,
but even in other places like the lining of the abdomen, the bowels and the bladder.
Doctors grade endometriosis based on how much of it is found during surgery. You can have a
little or you can have a lot. Sometimes endometriosis can be found by itself but
other times it can be found with scar tissue. Endometriosis can cause infertility by itself
though it's not completely clear why. Scar tissue can also make it difficult to get pregnant if
it makes it difficult for an egg to get into the fallopian tubes at the time of ovulation.
What are the methods you can use to increase the chance for pregnancy
if you have endometriosis? This turns out to be a huge topic so I am going to split
it up into a couple of episodes. In this episode I am going to talk about surgery
Most of the time, endometriosis surgery is performed using laparoscopy. For people
with mild endometriosis, we have two excellent studies, one from Canada and
one from Italy. In both studies, people with mild endometriosis were split into
two groups. Group 1 had their endometriosis treated at the time of surgery. Groups 2 had
their endometriosis confirmed during surgery but it was not treated. Both groups were then
allowed to attempt pregnancy without any other interventions for 9 to 12 months.
The results were interesting. People became pregnant whether they had their
endometriosis treated or not. This is important because it means that
untreated mild endometriosis does not make it impossible to become pregnant. However,
there were more pregnancies in the group that had their endometriosis removed during
surgery. But not a lot more. In the end, doctors would have to find and treat 12
patients with mild endometriosis in order to get one more pregnancy than an untreated group.
Here are some questions I get from my patients about surgery for endometriosis.
How long should you try to conceive after surgery before resorting to
other treatments? A Korean study found that of those people who became pregnant,
nearly all of the pregnancies occurred within 6 months. If pregnancy has not
occurred within 6 months, it is reasonable to start considering additional treatments.
What if you have severe endometriosis? Unfortunately,
we don’t have studies that compared the results of surgical treatment to
an untreated group like I discussed earlier for mild endometriosis. One study found that
after two years about 45% of people with severe endometriosis were able to conceive.
One word of caution here. People with severe endometriosis often have endometriosis which
grows inside of the ovary, this causes cysts to form called endometriomas which can be seen on
ultrasound. Surgery to remove endometriomas can reduce the reserve of eggs and actually
make it harder to become pregnant. I talk about that more in this video.
What if you had surgery for endometriosis once and you did not conceive? Will a second
surgery be helpful in improving the odds for pregnancy. The answer seems to be no.
Additional surgeries for fertility only are therefore not recommended
Is robotic surgery better for endometriosis? Well, it depends on the surgeon. Robotic surgery
is still performed using laparoscopy but the surgeon uses joysticks to control mechanical
arms which hold the surgical instruments. Some claim that this may allow greater precision,
but highly skilled surgeons can often accomplish the same thing. There is
no evidence that pregnancy rate after endometriosis surgery is any better.
In future episodes, I will discuss the use of medications and assisted reproduction
techniques like IUI and IVF. Be sure not to miss those episodes.