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Does endometriosis affect IVF?

6 fertility expert(s) answered this question

Answer from: Luciano Nardo, MD, MRCOG

Gynaecologist, Subspecialist in Reproductive Medicine, CEO & Founder, NOW-fertility
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There is no evidence that endometriosis affects the IVF outcome. As I mentioned earlier, endometriosis affects the anatomy of the pelvis and that obviously can be overcome by assisted conception treatment. However, there are some publications to suggest that women with endometriosis may have a disorganised and not in phase endometrium which could potentially affect embryo implantation. In my opinion and in line with our best practice and some recommendations, women that have endometriosis will be better treated with some protocols whereby the hormonal system is put into that stage of the temporal menopause so that will enable the endometrium, the lining of the womb also to be reset and therefore the better pregnancy outcome. No studies have shown that women that have endometriosis have a less likely outcome from assisted conception.

Answer from: Tomas Frgala, PhD

Gynaecologist, Head Physician at UNICA Clinic - Brno
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Certainly it does. It may be one of the reasons why the patient actually starts the IVF or the couple starts the IVF process. If the endometriosis happens to grow directly in the ovaries, lowers the ovarian reserve, then that might be one of the causes for infertility, for the problems in the couple. During the stimulation itself, we need to take that into account, we need to see where it’s located. If it’s directly in the ovary, it might have an influence on the dose of FSH that’s applied during the stimulation. It certainly calls for a very careful approach during the oocyte pickup (we don’t want to injure the endometriomas in the ovaries to avoid further spread). The number of eggs obtained might be lower and the receptivity of the endometrium might also be influenced. However, even in these patients, there are various ways we can help and the ovarian stimulation still can be very successful in the cases where the endometriosis has progressed (where the patient has lost the ovarian reserve), there’s still a chance for a pregnancy with egg donation.

Answer from: Ahmed Elgheriany, MRCOG, MD, MSc

Gynaecologist, Fertility Specialist GENNET City Fertility

Reproductive treatment outcomes so, if we are speaking about the endometriosis and assisted reproductive techniques or outcome, if we are doing ICSI for an infertile couple who have endometriosis, we will need to look for how many eggs we got, how is the performance of the quality of the egg itself, what is the implantation rate, what is the livee birth rate, is there any miscarriage or no. So, all the literature showing that it could affect the oocyte quality itself and the numbers of oocytes itself could be decreased but once the fertilization happens, if we are transferring back embryos, it has no effect on that. Same pregnancy rate, same live birth rate after fertilization.This is a very critical point and it differs upon the stages of endometriosis. So sometimes it could be better to postpone the embryo transfer and do “freeze all embryos”. So you are having this storm of hormones settling down, your body is just going back to normal and proceeding with frozen embryo transfer and this can even increase the cumulative frequency in cases of endometriosis. So don’t worry about the quality of the eggs – end point – live birth rate, miscarriage rate are similar to non-endometriotic patients.

Answer from: Andrew Horne, Professor

Gynaecologist, Co-Director EXPPECT Edinburgh, Chair of Academic Board RCOG, Professor of Gynaecology and Reproductive Sciences at The University of Edinburgh 
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Patients who have endometriosis and who undergo IVF do tend to do quite well in general. I wouldn’t say there’s a specific correlation. It would be very difficult. You can’t really sort of associate, for example, stage with a better outcome. We know that patients generally do well but we don’t have any specific data or figures that can be provided to them.

Answer from: Solvita Funka, MD

Gynaecologist, Reproductologist & Obstetrician EGV Clinic
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Endometriosis is a disease that can affect the fertility of women. Women undergoing IVF treatment or ICSI with endometriosis have a lot can have a lower number of retrieved oocytes and higher cycle cancellation rates compared with the women without endometriosis. It’s essential to individualize the treatment of the woman with endometriosis. Patients with more severe endometriosis stage 3 or 4 had a poor reproductive outcome and the women with endometriosis could have a higher dosage of FSH or for a woman with a longer stimulation or they can have a lower antral follicle. Count. However, it’s still unknown what the exact pathological factors are about endometriosis, for example, one of the reasons could be oxidative stress which can result in poor quality of their oocytes.

Answer from: Jana Bechthold, MD

Gynaecologist, Reproductive Gynecologist Clinica Tambre
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Endometriosis is a condition where the endometrial tissue is found outside. More or less, 10 to 15% of women of reproductive age are affected. These women can suffer from symptoms like chronic pelvic pain, infertility, but they can also have no symptoms at all. Around 30-50% of women with endometriosis suffer from infertility. In these cases, reproductive treatment is suggested.

So can endometriosis affect the outcome of an IVF cycle? Yes, there are studies that show that endometriosis can affect fertility but the mechanisms are still not completely known. The causes can be reduced endometrial receptivity, lower ovarian reserve but also lower quality of oocytes and embryos.

The studies have shown that when we compare the IVF cycles of women with endometriosis and women without endometriosis there can be a slight difference in the outcome so that the endometriosis has a negative effect on the IVF results. However, there have been studies that showed the results were similar. So this question is not so easy to answer. The important thing here is that women with severe endometriosis can have lower outcomes of the IVF cycles than women with light endometriosis. Also, there are studies showing that women who underwent surgery had better outcomes when the IVF cycle took place just a few months after the surgery.

To sum it up, IVF outcomes can be affected by severe endometriosis but it doesn’t mean that all women with endometriosis are affected.

About this question:

Is there a correlation between endometriosis and IVF outcome?

Endometriosis is a full body and often painful condition in which tissue similar to the uterus tissue — the endometrium — grows outside your uterus. Many women suffering from endometriosis can fall pregnant naturally. But more than 30% of women with endometriosis have trouble getting pregnant. In patients with severe endometriosis, e.g. Stage 4, the abnormal scar tissue may block the ovaries from releasing the eggs. Hence, endometriosis patients often turn to IVF for solutions.

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Fertility Road Magazine
The only magazine for patients devoted to IVF treatment.
15 articles & 68 pages of "All About IVF"