Choosing the Right Path: Navigating Treatment Options for Infertile Women with Endometriosis
June 20, 2023

Many infertile women with endometriosis are not sure what they should do, especially when they suffer from pelvic pain, because the options their gynecologist will offer them will be either using medical therapy to suppress the periods and thus relieve the pain, but this is only temporary; or doing surgery, which can remove the chocolate cyst and help to relieve the pain for some time, but it cannot stop the pain from coming back, because the cyst can recur, which means they're back to square one. And what's even worse is that every time you do the surgery, you also end up reducing your ovarian reserve, which means you may end up reducing your chances of ever having a baby, because as with everything else in life, there is always a trade-off! You need to balance what your ovarian reserve is ( something you can measure by checking your blood AMH level and testing your antral follicle count); how strong your desire about having a baby is; what the risk of recurrence is; how severe and disabling your pain is; and what your future fertility requirements and needs are. Now, for example, for women who have disabling pain and don't want any more babies, the solution is simple. Just do radical surgery, remove the uterus and the ovaries, and the pain will go away, but then obviously the price you pay for that is that you can't have a baby. Whereas if having a baby is much more important, then I'd strongly suggest that you consider doing IVF rather than doing surgery because while IVF will not solve the endometriosis problem, it will bypass the problem, which means not only will it give you the baby which you want, it will allow you to complete your family! Equally importantly, once you get pregnant, you will be pain-free for the nine months of your pregnancy as well as while you are breastfeeding, so you can kill two birds with one stone! In case, you do have a cyst, you can always puncture/ aspirate this under vaginal ultrasound guidance. There is no need to do laparoscopic surgery to treat this. And the good thing about IVF is you can always do your surgery after you've had your baby, so this pathway keeps all your options open. So please weigh the pros and cons carefully when deciding. The effects of surgery are irreversible, and you don’t want to end up jumping from the frying pan into the fire just because your gynecologist is trigger-happy.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.