Navigating Endometriosis and IVF: A Comprehensive Guide

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Alexa Davidson • Mar 24, 2024

Life with endometriosis can be an ongoing battle. After years of dealing with painful flare-ups, many women experience its next cruel symptom: infertility.

An estimated 30-50% of women with endometriosis have difficulty conceiving. But since it takes an average of 7-10 years to get a diagnosis, many are first told they have unexplained infertility.

Whether your endometriosis is confirmed, suspected, or more of a gut feeling, IVF can help you overcome underlying issues contributing to infertility. 

In this article, Dr. Charles E. Miller, an internationally renowned minimally invasive gynecologic surgeon and infertility specialist at CCRM Fertility, shares what you should know about navigating IVF with endometriosis. Find out which potential challenges to anticipate and the best questions to ask your fertility specialist before starting IVF.

How does IVF help with endometriosis?

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside of the uterus. It can appear in areas like the bladder or bowels, but the pelvis is the most common site. Although not classified as an autoimmune disorder, endometriosis is associated with chronic inflammation, characteristic of autoimmune disease.

In addition to inflammation, endometrial growth can cause scarring or adhesions in the pelvis. This affects the way the reproductive organs function and may cause problems like:

  • Diminished egg count or quality

  • An uninhabitable environment for sperm to fertilize an egg 

  • Blockages in the fallopian tubes

  • An environment that prevents an embryo from implanting

In vitro fertilization, or IVF, is a reproductive technology that involves developing an embryo outside of the womb before placing it into the uterus. By assisting with each part of the conception process in a controlled environment, fertility specialists help overcome barriers to getting pregnant.

If you have endometriosis, IVF can help by taking over two main processes: egg fertilization and embryo implantation. By working with an infertility specialist, you can create a plan to overcome whichever obstacles endo is causing.

How endometriosis affects IVF (and vice versa)

IVF involves using hormonal medications to stimulate ovulation and prepare the womb for implantation. However, because endometriosis is an estrogen-dependent condition, hormone exposure is a common cause of endometriosis flare-ups. “Especially when the ovaries are involved, more medication is often necessary, and unfortunately, retrieval cancellation rates are higher,” says Dr. Miller.  

As you begin working with your IVF doctor, ask about the plan for pain control and mention your typical triggers. Depending on your situation, your doctor may recommend surgery to remove endometrial tissue before moving forward with treatment. 

Dr. Miller says, “Surgery to excise the disease or medical treatment to suppress peritoneal endometriosis may be necessary prior to implantation.” Removing inflammatory tissue or cysts helps to create an environment where an embryo can thrive. 

Questions to ask before starting IVF with endometriosis

Before beginning IVF with endometriosis, you’ll want to know how the process will look — and if it involves surgical treatment. Dr. Miller recommends asking the following questions when working with an IVF doctor. 

1. Why do you suspect endometriosis?

You want to know if your doctor is making the diagnosis and treatment plan based on symptoms or imaging. Dr. Miller says you’d be looking for “evidence of deep infiltrative disease or endometrioma (cysts of endometriosis)” on imaging. 

2. How do you anticipate treatment of the endometriosis?

This determines whether it’ll be treated through medication or surgery.

3. Should surgery be performed before an egg removal?

Dr. Miller says that surgery can negatively impact ovarian health. It’s important to find out if surgery can be delayed until after the egg retrieval.

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4. What will the surgical approach involve?

Find out if the surgeon plans to do an ablation or an excision of endometrial tissue. Dr. Miller recommends excision as the preferred surgical technique.

5. Who will perform the surgery?

Dr. Miller recommends seeing a minimally invasive gynecologic surgeon for endometriosis treatment. “Ideally, a reproductive surgeon with extensive experience treating, and most importantly, excising endometriosis.”

Tips for navigating IVF with endometriosis

Dr. Miller emphasizes the importance of finding an infertility specialist who understands the impact of endometriosis. This is especially important if you have endometriomas (a type of fluid-filled cysts in the ovaries), which can impact egg retrieval or implantation.

If your doctor recommends surgery, remember to advocate for yourself by finding a surgeon who’s the right fit. “Even though your infertility specialist may simply want to send you back to your gynecologist for surgical treatment, you should ideally consult with a reproductive surgeon who performs minimally invasive gynecologic surgery,” he says. “The first surgery has the best chance of success.”

Alexa Davidson is a registered nurse and freelance health writer. She’s written for various women’s health companies, covering topics like natural hormone balance, fertility, and disease prevention. On her own fertility journey, Alexa has experienced profound loss and is passionate about supporting others with similar experiences. When she’s not researching or writing, Alexa can be found in the kitchen, where her specialty is making healthy versions of comfort foods. Nashville Hot Tofu, anyone?