Endometriosis and Infertility: Can Surgery Help?


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What is endometriosis?

Endometriosis is when tissue is found outside the uterus that appears similar to the lining of the uterus (endometrium). Endometriosis may grow on the outside of your uterus, ovaries, and tubes and even on your bladder or intestines. This tissue can irritate the structures that it touches, causing pain and adhesions (scar tissue) on these organs.

How can I tell if I have endometriosis?

Many women with endometriosis have pelvic or abdominal pain, particularly with their menstrual bleeding or with sex. Some women have no symptoms. Endometriosis can make it difficult to become pregnant. In fact, 30% to 50% of infertile women have endometriosis. Sometimes, endometriosis can grow inside your ovary and form a cyst (endometrioma). This usually can be seen on ultrasound, unlike other endometriotic tissue. The only way to tell for certain if you have endometriosis is through a surgical procedure called laparoscopy.

How is laparoscopy performed?

Laparoscopy is called “minimally invasive” surgery because the surgeon makes very small incisions at (or around) your belly button and lower portion of your belly. A thin telescope-like instrument (the laparoscope) is placed into one incision, which allows the doctor to look for endometriosis using a small camera. Small instruments are inserted through other incisions to remove the tissue and adhesions. You usually can go home the day you have your surgery and should be able to return to your usual activities. The risk of complications is extremely small.

Will I be able to get pregnant after the surgery?

Laparoscopy can provide useful information to help determine how to get pregnant and when to undergo fertility therapy. At the time of surgery, your doctor may evaluate the amount, location, and depth of endometriosis and give you a “score.” This score determines whether your endometriosis is considered minimal (Stage 1), mild (Stage 2), moderate (Stage 3), or severe (Stage 4). This scoring system correlates with pregnancy success. With more minimal endometriosis, removing or destroying endometriosis can increase your chances of becoming pregnant naturally. If you do not get pregnant within a reasonable time frame after the surgery, it probably won’t help to have surgery again unless there is a new problem.

With more advanced endometriosis (Stages 3 or 4), surgery can help restore your normal pelvic anatomy to allow the ovaries and fallopian tubes to work better. Surgery to remove large endometriomas may also improve fertility rates. There is a limit as to how much surgery can improve pregnancy rates. Treatment should be individualized and should consider all available methods to help you become pregnant.

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Resources For You

The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.

Endometriosis

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Managing Pelvic Pain

Many women have pain in their pelvis (lower part of the belly) from time to time, usually during their period. View the fact sheet
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What do I need to know about conceiving after tubal surgery?

Fallopian tubes connect the ovary (where the eggs are stored and grow) to the uterus (womb), where the fertilized egg develops into a baby (fetus). View the fact sheet
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SART Fertility Experts - Endometriosis

Endometriosis is a condition that can affect many facets of a person’s life, from pelvic pain to struggles with infertility.   Listen to the Episode
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Infertility: an Overview (booklet)

Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
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Endometriosis: Does It Cause Infertility?

When tissue like the tissue that normally lines the inside of the uterus (endometrium) is found outside the uterus, it is termed “endometriosis.” View the Fact Sheet
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Hydrosalpinx

The fallopian tubes are attached to the uterus (womb) on the left and right sides. View the Fact Sheet
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Endometriosis

Endometriosis is a condition in which endometrial tissue, which normally lines the uterus, develops outside of the uterine cavity in abnormal locations. Watch Video
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Causes of Female Infertility

Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of female infertility. Watch Video
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Endometriosis (booklet)

Women with endometriosis may experience infertility, pelvic pain, or both. This booklet will describe options for diagnosing and treating pain or infertility that may be attributed to endometriosis. View the Booklet
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Noncontraceptive Benefits of Birth Control Pills

Most women will use birth control pills at some time in their lives. View the fact sheet
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Endometriosis Infographics

ASRM has prepared infographics to illustrate the subject of Endometriosis better. View the Infographics

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