Endometriosis & IVF

Although IVF has helped greatly to improve the chances of pregnancy for patients with endometriosis however outcomes of in vitro fertilization cycles in women with endometriosis are significantly worse than in patients without this condition.

Because of the use of IVF, information is available about embryo quality and rates of cell division, implantation and pregnancy loss. Abnormalities in the nucleus and cytoplasm of embryos from women with endometriosis are six times more frequent than in women without endometriosis. These abnormalities include cytoplasmic fragmentation, darkened cytoplasm, reduced cell numbers and increased frequency of arrested embryos leading to significantly fewer transferable embryos.

The impact of endometriosis on ovarian reserve and the quality of retrieved oocytes is evident. Lower implantation rates, however, raise the question whether this finding is purely the consequence of lower number and poorer quality of embryos, or whether it also reflects compromised endometrial receptivity.

Implantation problems are not limited to regular IVF. In oocyte donation cycles, a recipient's history of endometriosis might have a negative impact on implantation, pregnancy and live birth rates In a recent study doctors split the eggs from the same donor in recipients with and without a history of endometriosis. The interesting thing about this study is that the women in this study had been in menopause for at least 1 year prior to attempting egg donation. The implantation and pregnancy rates were significantly lower in the endometriosis group compared with the control group (23.81% versus 31.48%, P = 0.019; 45.00% versus 58.33%, P = 0.039, respectively).

Endometriosis IVF

The current scientific evidence suggests that patients with infertility of long duration, failed IVF cycles and implantation failures who demonstrate any of these findings

  • Clinical symptoms of endometriosis
  • Signs of endometriosis
  • Immunological testing linked to endometriosis
  • Clinical tests indicative of endometriosis

Should have a laparoscopic evaluation for the presence of endometriosis.

The appropriate surgical method to treat endometriosis is excision (removing the disease whereby a specimen is produced and sent to pathology).

Although ablation (destruction of the disease with energy without a specimen being produced) may offer a temporary solution it is an inadequate approach in cases in which the endometriosis is implanted deeper into the tissue.

Below is an example of an area of superficial endometriosis that was appropriately resected:

Resected Endometriosis

It is also of vital importance that the doctor performing the surgery is committed to spend the time to identify all the possible endometriosis lesions. Many fertility doctors have developed a bias and are not fully committed to removing endometriosis implants.

Our experience, as confirmed in the current literature, has shown that the proper identification and removal of endometriosis yields to improved fertility and miscarriage treatment outcomes.

Find more information about endometriosis.

Selected References

Opoien HK, Fedorcsak P, Byholm T, Tanbo T. Complete surgical removal of minimal and mild endometriosis improves outcome of subsequent IVF/ICSI treatment. Reprod Biomed Online 2011;23:389-395.

Nowroozi K, Chase JS, Check JH, Wu CH. The importance of laparoscopic coagulation of mild endometriosis in infertile women. Int J Fertil 1987;32:442-444.

Stilley JA, Birt JA, Sharpe-Timms KL. Cellular and molecular basis for endometriosis-associated infertility. Cell Tissue Res. 2012 Sep;349(3):849-62. Review. PubMed PMID: 22298022;

Yeung P Jr. The laparoscopic management of endometriosis in patients with pelvic pain. Obstet Gynecol Clin North Am. 2014 Sep;41(3):371-83. doi: 10.1016/j.ogc.2014.05.002.

Barri PN, Coroleu B, Tur R, Barri-Soldevila PN, Rodríguez I. Endometriosis-associated infertility: surgery and IVF, a comprehensive therapeutic approach. Reprod Biomed Online. 2010 Aug;21(2):179-85. doi: 10.1016/j.rbmo.2010.04.026

Hjordt Hansen MV, Dalsgaard T, Hartwell D, Skovlund CW, Lidegaard O. Reproductive prognosis in endometriosis. A national cohort study. Acta Obstet Gynecol Scand. 2014 May;93(5):483-9.