Endometriosis is a chronic disease whose etiology is not completely understood. Endometriosis is prevalent affecting 25% to 50% of infertile women and approximately 30% to 50% of women who have endometriosis are infertile. Endometriosis may cause infertility by:
- distorting pelvic anatomy
- causing endocrine and ovulatory abnormalities
- inhibiting implantation
- impairing egg and embryo quality
- altering peritoneal function
- causing abnormal transport of the egg and embryo in the fallopian tube
- adversely affecting hormonal and cellular immunity
IVF remains the best course for infertile women with endometriosis desiring a baby since surgery with excision of endometriomas in the ovary may lower ovarian reserve especially in cases of endometriosis in both ovaries. Surgery should be reserved for those with pain. If surgery is indicated then removal of the cysts rather than cyst drainage and coagulation/ablation should be performed. Surgery does not benefit asymptomatic women with an endometrioma prior to and IVF cycle. Pregnancy rates are better with IVF than repeat surgery in cases where surgery has been previously performed. Recent evidence suggests that the addition of Letrozole to the ovarian stimulation protocol in addition to gonadotropins for IVF may be better than gonadotropin stimulation alone.
If you suffer from endometriosis and have questions, please contact us. We are here to help!