Gynaecologist & Endoscopic Surgeon

Complete surgical removal of minimal and mild endometriosis improves outcomes of subsequent IVF/ICSI treatment

 

An excellent article published earlier this year sheds further light on fertility problems in patients with endometriosis. 

Until recently it has been widely thought that when faced with the situation of difficulty conceiving the option has been either IVF or surgery aiming to treat endometriosis.  We have known for some time that endometriosis has a stage related effect on your chance of conception.  It has been thought that IVF could largely bypass these problems.  Recent data such as this and anecdotally our results and that of others working in the field support the notion that removing the endometriosis and optimizing the pelvis results in improved outcomes at subsequent assisted reproduction.  In this particular paper 661 infertile women with minimal and mild endometriosis underwent a total of 1,604 treatment cycles.  The study shows that these women have significantly shorter time to pregnancy and higher live birth rates if all visible endometriosis is completely eliminated prior to assisted conception.  Currently many people do not undergo laparoscopy prior to IVF.  I believe this gives increasing evidence that a careful history should be taken and if there are signs of endometriosis then consideration could be given to taking an endometrial biopsy to confirm this and then proceed to laparoscopy.  This strategy appears to result in a shorter time to pregnancy and higher live birth rates. The data are not yet in but this is strategy is likely to be even more successive with the more severe forms of endometriosis as I outlined in an earlier blog.

Michael Cooper