It isn’t uncommon for many infertile women to have endometriosis and fibroids as they are very common findings in women in the reproductive age group; fertile women have these as well. The unfortunate part is that when a gynecologist sees endometriosis and fibroids in an infertile woman, more often than not, he will advise endoscopic surgery to remove the fibroid and to treat the endometriosis (even if he plans to refer this patient for IVF).

The logic he is working on is that the laparoscopy procedure will help “cleanup the pelvis” and that it will improve the chances of embryo implantation. Many gynecologists tell their patients that fibroids can grow during pregnancy, and that they can cause a miscarriage. Continuing on this strain of logic, they tell their patients that it’s best to remove the fibroids before they start on IVF.

Read more-Laparoscopy and laparoscopic surgery

Are these really "Abnormalities”?

I do see many patients who have been referred to me, who have had these interventions; to a certain degree, it’s because modern ultrasound technology has advanced to a great extent and machines have very good resolutions- they are able to pick up even the most minuscule (one centimeter is size) endometriotic cysts and fibroids. In fact, I say with utter confidence that even the most fertile women will have at least one such abnormality.

The question of a laparoscopy comes to the fore because when the ultrasonographer sees these " lesions”, he is required to report them. As a matter of fact, his report will highlight these as abnormalities. The doctor picks up these, and then explains to his patients that these will have to be corrected before she does IVF. The patients are clueless and this explanation sounds logical to them; it’s why they agree to sign up for the surgery.

Read more-Fibroids and infertility

What's the Advantage?

Sadly, this surgery isn’t of any use whatsoever. Typically, fibroids are just innocent bystanders; they do not have a negative impact on fertility as long as they don't encroach upon the endometrial cavity. In the same vein, there isn’t any specific advantage to treating endometriosis prior to IVF. It doesn’t improve the embryo implantation rates in any way.

On the contrary, this particular surgery can actually have a negative impact on IVF pregnancy rates; this is because every time the endometriotic tissue is removed from your ovaries, the normal ovarian tissues are also sacrificed and this reduces your ovarian reserve. In simple words, you will end up growing fewer eggs and there will be less embryos to transfer.

If your gynecologist thinks you need IVF, and suggests that you do endoscopic surgery before referring you to an IVF specialist, it's best to meet the latter first, and ask him if the surgery is really necessary, before you agree to getting the surgery done.

Not happy with the attention you are getting from your IVF clinic? Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you!

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

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