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Endometriosis Surgery Before IVF?

Posted Sep 25 2009 3:34pm
My wife really hates checking the mail. “There is never any good news in that mailbox,” she usually comments as I carry the heaps of LL Bean catalogs in from the street. Well, yesterday there was something good in the royalty check for sales of that famous book “100 Questions and Answers about Infertility.” As I eagerly opened the envelope dreams of a new car (mine has 119K miles on it) or a new TV (we still have one with a built-in VCR in one room) or even helping to pay for my son’s college tuition (yearly bill is too shocking to report here) danced in my head.

I ripped open that envelope and saw that I would receive the whopping amount of $347.34 for my portion of the royalties over this past year.

So clearly I need to act. There can be only one answer…I need to blog more and apply guilt more freely. My patients have usually figured out that I am an easy mark when it comes to applying guilt (nod if you agree). I blame this on being raised in Jewish household before I converted to Christianity. If I had become Catholic rather than Presbyterian the guilt issue would have worked out easier. So now I need to turn the tables on you…dear readers. Where are all those 5 star reviews? Why has Oprah not called me yet? Why is our book not a Book-of-the-month Club selection? Beats me but I need to sell a lot more books to get that new car.

But enough light-hearted banter, we need to get to work so you all have time to log on to and post those reviews that state that our book is much better than any of those in the "Twilight" series.

So let’s return to excerpts from that wonderfully informative book and address a question that arose in several of my patients this week…

39. Do I need endometriosis surgery if I am already planning to pursue IVF?

This is a somewhat controversial area of reproductive medicine. Most reproductive endocrinologists do not recommend surgery prior to IVF unless the woman has advanced endometriosis, such as an ovarian endometrioma. For women who have only mild to moderate endometriosis, IVF is associated with excellent pregnancy rates even without surgery. When advanced endometriosis is present, such as an ovarian endometrioma, its surgical removal prior to IVF may enhance the chances for a successful IVF outcome and may decrease infectious complications related to egg collection. Thus, in such cases, most reproductive endocrinologists routinely recommend the removal of advanced endometriosis prior to treatment using IVF.

However, severe endometriosis with endometriomas may lead to diminished ovarian responsiveness, and ovarian surgery may further compromise fertility in such cases. So the decision to perform extensive surgery for endometriosis must be weighed against the potential impact of that surgery on the ovary. Also, advanced endometriosis may increase the likelihood for an early pregnancy loss or spontaneous abortion. By first removing the endometriosis, the outcome of pregnancy is greatly improved.
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