Endometriosis & Infertility

How can endometriosis affect my fertility?
While some women diagnosed with endometriosis have previously been pregnant or will become pregnant in the future without any problems, many women with this condition do experience difficulties conceiving naturally. Endometriosis can impact upon fertility in a number of ways: mechanically (scarring associated with the disease can restrict the motility of the tubes and prevent egg cells from passing from the ovary to the tube), biochemically (endometriosis is associated with biochemical changes that can result in a “toxic” pelvic environment that may not be conducive to successful conception and development of an embryo), reduced ovarian reserve (both the presence of ovarian endometriomas and repeated surgeries on the ovaries can affect the quality and quantity of egg cells remaining in the ovaries), and radical treatments (if a patient is advised her only option is to have her reproductive organs removed to “treat” her endometriosis, she will be rendered infertile and will enter surgical menopause).

Endometriosis can impact upon fertility in a number of ways: mechanically (scarring associated with the disease can restrict the motility of the tubes and prevent egg cells from passing from the ovary to the tube), biochemically (endometriosis is associated with biochemical changes that can result in a “toxic” pelvic environment that may not be conducive to successful conception and development of an embryo), reduced ovarian reserve (both the presence of ovarian endometriomas and repeated surgeries on the ovaries can affect the quality and quantity of egg cells remaining in the ovaries), and radical treatments (if a patient is advised her only option is to have her reproductive organs removed to “treat” her endometriosis, she will be rendered infertile and will enter surgical menopause).

Importantly, patients need to be aware that finding a surgeon with a high level of surgical skill is essential when undergoing surgery for endometriosis. The skill of the surgeon will help determine whether the disease is fully addressed during a single surgery, whether damage to healthy ovarian tissue is kept to a minimum (if ovarian disease is present), and whether the reproductive organs are retained and preserved. The treatment of endometriosis should never necessitate the removal of healthy reproductive organs in a woman who wishes to preserve her fertility. Even in the case of severe ovarian endometriosis, healthy ovarian tissue can almost always be preserved to enable the woman to have a family in the future.
 
Why should endometriosis-associated infertility be treated surgically?
Research has found that women with endometriosis-associated infertility who have their disease carefully removed via excision have an increased chance of conceiving naturally after their surgery. Often couples come to me for care having already undergone previous failed IVF-attempts. Not only is IVF expensive but it also carries a heavy emotional toll on the couple when a cycle fails to end in a pregnancy. By surgically removing the endometriosis, many couples find that they are in fact able to conceive naturally despite having previously struggled with infertility for years with a history of failed fertility treatments.

By addressing the disease surgically not only is this an effective long-term treatment of the debilitating symptoms of endometriosis but it is also an essential foundation in preserving and restoring the woman’s fertility so that she has the best chance possible of conceiving naturally.
 
Why do reproductive endocrinologists not recommend surgical treatment for endometriosis?
Reproductive endocrinologists do not as a rule have the advanced expertise in minimally invasive surgery required to adequately manage endometriosis and are not necessarily aware of the benefits of skilled surgery to address both symptoms and infertility. For this reason they typically direct patients toward artificial reproductive therapies (ART), such as IVF, to address infertility while the patient is left to cope with the symptoms of the disease herself at home.
 
Restoring fertility in patients with severe endometriosis
Restoring fertility in patients with severe endometriosis often involves not only complete excision of all areas of disease but also delicate fertility microsurgery to restore tubal motility and function. Few surgeons are equipped with both the advanced skills needed to address complex cases of endometriosis as well as a specialism in delicate microsurgery. Dr. Koh has dedicated his career to both forms of complex minimally invasive gynecologic surgery to provide his patients with symptom relief and to preserve and restore their fertility wherever possible.

‘I am forever grateful that one day my son will learn how his life was made possible because of Dr. Koh and the exceptional care he provided.’ Read Michelle’s story