What is endometriosis?
The tissue lining the inside of the uterus is called endometrium. Menstruation comes from the shedding of this layer of tissue each month as a result of ovarian hormones.
Endometriosis develops from the retrograde (backward) flow of menstrual fluid through the fallopian tubes and subsequent growth of endometriotic implants in locations outside the uterus.
There is ample evidence linking endometriosis to infertility.
- For example, while endometriosis occurs in 5–10% of women with proven fertility, it may be found in up to 50% of infertile women.
- Infertility patients with untreated mild endometriosis conceive on their own at a rate of 2% to 5% per month, compared with a 15% to 20% monthly fertility rate in normal couples (ASRM 2016 Endometriosis – A Guide for Patients).
What is the role of surgery for endometriosis-associated infertility?
- Reproductive surgery is indicated in infertile women with normal ovulation and normospermic partners, regardless of pain symptoms or transvaginal ultrasound results as up to 50% may have endometriosis.
- In infertile women with stage I/II endometriosis, operative laparoscopy to excise or ablate endometriosis lesions and adhesiolysis, rather than performing diagnostic
laparoscopy only, is advised to increase ongoing pregnancy rates (Jacobson et al. 2010, Nowroozi et al. 1987).
- In infertile women with ovarian endometriotic cyst, surgical excision of the cyst is preferred to drainage and electro-coagulation to increase spontaneous pregnancy rates (Hart et al. 2008).
- In infertile women with stage III/IV endometriosis, consider operative laparoscopy, instead of expectant management, to increase spontaneous pregnancy rates (Nezhat et al. 1989, Vercellini et al. 2006a).
For a more detailed information pamphlet on this topic at The role of surgery for endometriosis- associated infertility