Monday, 7 April 2014

Endometriosis – Laparoscopy or IVF


A study shows that around 30 to 50 percent women with endometriosis experience infertility. Considering their problem different from other infertility patients, endometriosis patients find themselves wedged in a situation where they are confused between a Gynecologist and an Infertility Specialist.

It is advised for such patients to consult a gynecologist. With a quick reflex, most gynecologists would suggest you laparoscopy, terming it to be a definitive diagnosis method. It is true! Laparoscopy or "robotic surgery" or "3-D surgery", is a minimally invasive surgery which allows the doctors to temporarily treat endometriotis by removing the lesions. Unfortunately, unlike breast lumps, endometriotis lesions reoccur even after surgery.

Undergoing Laparoscopy might be a tricky decision. There are two reasons; first, there is no evidence that treating mild endometriosis improves fertility. Second, removing chocolate cysts, the doctor also ends up sacrificing normal ovarian tissue - and this further reduces ovarian reserve. This can make a bad problem worse, because often the endometriotic deposits themselves can damage ovarian function.

Sometimes, even fertile women have endometriosis, which can be ignored. So, if an endometriosis patient goes to an IVF specialist, he might suggest them direct IVF treatment. So, again the patients are confused.

If you are endometriosis patient, then you need to consider four factors, age, ovarian reserve, extent of your disease and whether or not you also have additional symptoms such as pelvic pain, for which you need relief. If you are older, then you should definitely go for IVF, as it not only maximizes the chances of pregnancy but the other diseases will regress. IVF would leave you pain free.

However, if you have additional disabling symptoms like rectal endometriosis, then you should first go for laparoscopy to effectively remove painful lesions before undergoing IVF

Sometimes, endometriosis diagnosis is incidental and for women who need to get pregnant should opt for IVF to maximize the chances of pregnancy because mild endometriosis most likely does not affect fertility at all - and can be left alone.


Secondly, the ovarian reserve, patients need to go for an antral follicle count and blood AMH level testing to ovarian function and normality of ovarian tissue in ovaries respectively. Opting for the Laparoscopy depends on the test results. 

Good AFC and normal AMH level can be a green signal for surgery while poor ovarian reserve might be a problem, as surgery can further damage the ovarian reserve. In such a situation, it is suggested to opt for IVF directly. 

Dr Neeraj Pahlajani

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