Endometriosis – Is surgery before pregnancy recommended?

March is endometriosis awareness month and so we asked the fantastic team at Clinica Tambre to give us the lowdown on the common condition and how it can affect your fertility

Clinica Tambre’s Dr Blanca Paraíso, fertility expert, tells us about the most recommended fertility treatments in cases of endometriosis.

What is endometriosis?

Endometriosis is a disease that affects ten to 15 per cent of women of childbearing age. Endometrial tissue (that lines the uterus cavity) appears in other places in the pelvis in form of nodules or cysts in the ovaries, also called endometriomas. The cause is still unknown, but it is believed that it may have a hereditary, immune and endocrine component related to the hormones of the menstrual cycle.

How to know if I have endometriosis?

Its diagnosis is complex, since in up to 50 per cent of cases the patients do not have any symptoms. The most frequent way to control the existence of endometriosis is through the visualisation of endometriomas in an gynecological ultrasound scan, but these are not always present. In other cases it can be diagnosed due to intense pain during menstruation, during sexual intercourse, alterations in the intestinal rhythm or in menstrual cycles. Apart from the symptoms, it can also affect fertility: obstructing the fallopian tubes, decreasing the ovarian reserve, altering menstrual cycles and worsening the immune environment that will decrease embryonic implantation in the uterus.

How does it affect fertility?

It is common to think that fertility improves if endometriomas are removed through surgery, but nowadays the trend leads to a more conservative approach. It is true that surgery can improve fertility for these women, but the case must be well selected because an intervention can also have negative consequences on the ovarian reserve (number of eggs in the ovaries).

Currently, the size of the endometrioma, its growth over time and the symptomatology of women are evaluated. In the event that the endometrioma is large (bigger than for or five centimetres), growing very fast or that the woman has symptoms such as pain that clearly impairs their quality of life, surgery will be indicated. On the contrary, if there are no symptoms, the cysts are stable and of small size, it is usually recommended to try to conceive naturally or with assisted reproduction techniques before having surgery. Pregnancy is a very favorable hormonal situation for endometriosis, stagnating and even sometimes reversing its progression.

Therefore, the surgery recommendations, will depend on each woman’s conditions regarding symptoms, evolution of the disease and time of sterility. The most recommended and least invasive surgical technique is laparoscopy. It is important to be in the hands of professionals who assess the case and follow-up properly on the disease.

For Patients with mild endometriosis: What is more effective, in vitro fertilisation or artificial insemination?

“In terms of effectiveness, an in vitro fertilisation will always be more effective than an artificial insemination. But for patients with mild endometriosis, studies have observed an increase in the possibility of a pregnancy using artificial insemination in comparison to a spontaneous conception achieved through sexual intercourse. This increase will always be lower than for women without endometriosis, but it has been objectified.

“Additionally, we must keep in mind that in vitro fertilisation is not always available. For example, in the social security there are certain waiting lists and it is also a more expensive and complex procedure. Therefore, in most clinics, in the case of young patients with mild endometriosis, it is considered to try to achieve a pregnancy through artificial insemination before trying directly with in vitro fertilisation.

Does egg donation offer good results for patients with endometriosis?

“Scientific studies have shown that the main limiting factor for achieving a pregnancy for women with endometriosis is the egg.

There have been many concerns about this issue and several studies have been performed, because it is true that for these patients there may be a decreased endometrial receptivity and that embryos may be received worse. However, it has been observed that it is the egg that is going to give us the possibility of a pregnancy. In a study in which donor eggs were used for patients with endometriosis and without endometriosis, the pregnancy rates were the same.

Therefore, in general egg donation for patients with endometriosis will offer the same pregnancy rates as for patients without endometriosis that are quite high, between 60 to 70 per cent.”

Have you been diagnosed with endometriosis? March is endometriosis month, so we’d like to hear from you if you who have had a diagnosis and a subsequent fertility story, email mystory@ivfbabble.com

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