Is IVF less successful if a woman has endometriosis? This is an important question.
Some doctors have recommended treatment of endometriosis before IVF with surgery or months of
powerful medications to suppress your hormones. I get many questions about this. Does this make
sense? Might you get pregnant just as easily if you skip treatment for endometriosis and
just go straight to IVF? An interesting new study sheds some light on these questions. Stay tuned
What is endometriosis? Simply put, endometriosis is when the tissue which normally grows
inside of your uterus, instead grows outside of the uterus. It can grow on the ovaries,
your bladder or bowel or even on the inside walls of your abdomen.
In addition to infertility, endometriosis can cause pelvic pain.
What is the impact of endometriosis on IVF? The first part of IVF involves the use of fertility
medications to mature multiple eggs in the ovaries. Previous studies have demonstrated that
when endometriosis forms cysts in the ovaries, it results in a lowering of the number of eggs
and this results in less eggs being matured in IVF. Less eggs means less embryos produced
and if there are less embryos available, the chance for pregnancy with IVF
is lower. I talk about this in depth in this video. Check it out after you finish this one.
What if you already have a healthy embryo to transfer? Does having endometriosis still
make a difference? Some people believe that women with endometriosis also have problems
in their uterine lining that could prevent embryos from implanting. In some cases, they
recommend expensive tests to look for markers of endometriosis in a biopsy of the uterine lining.
When these markers are present, they recommend surgery or prolonged hormone suppression.
This study looked only at couples who had healthy embryos for transfer which were frozen at the
blastocyst stage and that were also tested to make sure that they did not have any chromosome
abnormalities. Three groups with healthy embryos were compared. The women in the first group
had proven endometriosis. The second group were couples who ONLY had some sort of sperm problem,
in other words, a problem with the male partner, not the female. The third group did not even have
infertility. These were couples who were doing IVF in order to avoid passing on a genetic mutation.
By using only normal, healthy embryos, the researchers were able to eliminate many variables
which could affect success rates and focus more specifically on the impact of endometriosis.
If endometriosis had some sort of negative effect on the uterine lining,
then those couples would have a lower chance for pregnancy. What did the results show?
The women in the three groups were very similar. They were about the same age. The number of eggs
retrieved were similar as was the fertilization rate, the percentage of embryos which reached
the blastocyst stage and the percentage of embryos which were healthy appearing under the microscope
and the percentage which had normal chromosome testing.
All three groups had roughly the same chance for a positive hCG blood test. About 75 to
80% of the women in all three groups had a positive pregnancy test. They also had the same
chance for getting to the point of seeing a pregnancy in the uterus on ultrasound,
what fertility doctors call a clinical pregnancy. Most importantly, all three groups had the same
chance for delivering a live born baby. This means that women with endometriosis
did NOT have a lower pregnancy rate and did NOT have a higher chance for miscarriage.
Our InfertilityTV bottom Line is this: The best available data today does not indicate that
IVF is less effective in women with endometriosis. At this time, I do not recommend spending
money on tests which are designed to find endometriosis with an endometrial biopsy.
I do not recommend doing surgery to treat endometriosis if the intention is to try
to improve the chances for IVF success and I do not recommend taking medications
to suppress your hormones for several months before having embryo transfer.
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