They say that even if you need IVF, the endometriosis will have to be surgically removed. Apparently the rationale behind this is that the cysts it will interfere with the IVF treatment cycle and reduce IVF pregnancy rates. Though this seems to make sense, it’s actually quite illogical. If you have endometriosis and need IVF, there is no need to do anything about the endometriosis per se, because the endometriosis is outside the uterine cavity and is not going to affect the embryos that implant in the uterine cavity.
A recent Human Reproduction paper, published March 2015, "Surgical diminished ovarian reserve after endometrioma cystecomy versus idiopathic DOR: comparison of IVF outcome"- Audrey Roustan, et al, proves that the chances of IVF success are decreased in women with diminished ovarian reserve after cystectomy for endometrioma. This is especially true for women with bilateral endometriomas.
Why is there such a difference of opinion? The reason stems from the over-specialization in the field of medicine. Every specialist focuses on nothing but his or her own specialty. A gynecologist who specializes in laparoscopic surgery will tell the patient that the endometriosis will have to be treated before she even considers getting infertility treatment. Because gynecologists don't have any training or experience in IVF, they don't realize the inadvertent harm they end up causing their patients by doing this surgery.
The physician can find this particular surgery very gratifying as the before and after laparoscopy images are quite impressive; this is because the removes the adhesions and clears the pelvis. While the pelvis may look much prettier after the surgery, this is not very useful because it does not help to improve the patient’s fertility.
Receiving conflicting advice can cause confusion but there is a very simple solution: The right patient has to be selected for the right treatment.
Ideally, a multidisciplinary team of doctors should treat endometriosis patients where both gynecologists and IVF specialists can provide their viewpoint, and the patient can weigh both perspectives and then make up her mind. The surgery may offer them a window of opportunity and if they understand the pros and cons, then it's an option worth exploring.
If she needs IVF, then she should could just go ahead, and not waste her time doing laparoscopic surgery before the IVF cycle.
The beauty is that once you do get pregnant with IVF, you will get significant relief from your pelvic pain, and your endometriosis will usually regress while you’re pregnant, and while you're breast-feeding as well.
If you are interested in receiving more information about your potential treatment options, please schedule an appointment with one of our board certified physicians today.
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