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What is the best fertility treatment for endometriosis?

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5 fertility expert(s) answered this question

Answer from: Sibte Hassan, MBBS, FCPS, MRCOG, MSc

Gynaecologist, Fertility specialist and Gynaecologist at London Womens Clinic
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It all depends obviously on the age of the patient and her egg reserve test, her tubal status (whether the tubes are open or not), the male partner’s situation or whether she’s using donor sperm. We just do not base the plan of fertility treatment on just one factor so, there are other factors involved as well. If our egg reserve is fine and she’s relatively younger and her tubes are open and tubal function is fine and the male partner’s sperms are fine, she could have insemination. Otherwise, if there is some tubal dysfunction or male factor problem or the egg reserve is low or the age is more than 38, 39 then usually IVF is the first recommended line of treatment. Egg donation is only used if the egg reserve is very low, negligible or the patient age is such that the quality of eggs or the disease severity is such that or previous assisted treatment IVF has failed then she might be a candidate for egg donation. So, it all depends on a combination of different factors, not on the basis of only one factor.

Answer from: Ahmed Elgheriany, MRCOG, MD, MSc

Gynaecologist, Fertility Specialist GENNET City Fertility
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Will IVF and ICSI make a difference? IVF is basically when we are collecting the eggs after your stimulation and we put the sperm around the egg and keep the fastest sperm to penetrate the egg and do fertilization. This semi-natural process for the sperm. If we have any suspicion about the sperm or any concern that the sperm is not good, we are doing ICSI (Intracytoplasmic Sperm Injection). We are injecting this sperm inside the egg itself and once we have done that, we wait for fertilization. Until now very very recent study because there are some people that will recommend ICSI for endometriosis and IVF for endometriosis and no difference on the outcome, nor the oocytes equality, nor eggs equality, nor live birth rate, nor embryo implantation – nothing different. So, if you have any other risky factors in the sperm so do ICSI but otherwise it will not affect the pregnancy outcome.

Answer from: Anu Chawla, MRCOG, MBBS, M.S., DNB

Gynaecologist, Specialist in Reproductive Medicine
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If at all we’re doing IVF, in such a case then, if the genetically tested normal euploid blastocyst is there then, the chances are pretty much good. IUI intrauterine insemination also has a place in cases of mild endometriosis. Sometimes, these patients sub-clinical endometriosis never gets diagnosed and these patients get classified as unexplained subfertility patients because no one did the laparoscopy and the subclinical or small patches would not show in the ultrasound so, a completely normal ultrasound does not mean that the woman does not have endometriosis because the gold standard of the diagnosis of endometriosis is a surgery which is a laparoscopic surgery and the surgery has to be done when it is indicated so, we cannot just do a laparoscopic surgery just to diagnose. Sometimes these patients get classified as the unexplained group of sub-fertility patients but actually they might actually have the mild or subclinical endometriosis and such patients will benefit from intrauterine insemination so, all three options are there for them: the sexual intercourse and IUI intrauterine insemination or the IVF but like I explained maybe in future, we would assume that as far as if IVF outcomes are concerned, they might not be very different if at all we actually do have the normal euploid genetically tested normal blastocyst.

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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It depends on the grading of the endometriosis. If you have stage I or stage II or what we call minimal to mild disease, we know that if you have surgery, that will improve your chances of getting pregnant. It’s less clear for other stages and often patients may choose rather than to have surgery to undergo fertility treatments such as IVF which can be helpful. The important message here is that hormone treatments whilst they might be helpful for the pain associated with endometriosis, they’re not helpful in the fertility context.

Answer from: Shamma Al-Inizi, FRCOG

Gynaecologist, Consultant obstetrician & Gynaecologist at South Tyneside & Sunderland NHS Foundation Trust UK
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I will say no. IVF is always very helpful in many conditions and it’s beneficial but in terms of endometriosis, this depends on the stage. Most societies, the European, the British and the American, recommend for early staging to use laparoscopic treatment. This will definitely improve the chances of this lady to conceive. So, first of all we offer a laparoscopy, we perform it, we confirm endometriosis, we treat it and there are different options for treatment: excision of endometriosis, ablation of endometriosis by either diathermy laser or helium. All these will help, first of all the symptoms of pain related to endometriosis, pain with intercourse, pain with periods, the chronic pelvic pain and also they will definitely improve fertility so, there’s no question about this. So many conditions, in many cases, once we treat the endometriosis laparoscopically, the lady will conceive naturally and if she needs any help with the ovulation induction will do that. Sometimes we offer and try insemination before the last step will be to go for IVF. Of course, if we fail to help the lady with these simple options, the next step will be IVF or a more advanced endometriosis where everything is stuck, with a lot of scarring, tubes are blocked of course, IVF will be the best option for endometriosis. So, it’s not always that we jump to the idea of a conclusion.

About this question:

Is IVF the best option for endometriosis?

What are the options to deal with endometriosis? Is IVF needed to get pregnant? Is surgery the only option to proceed with natural pregnancy?

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