Over 10% of the females in reproductive age suffer from endometriosis , according to the World Health Organization (1). While many of them are able to conceive naturally despite the condition, many also need medical intervention and IVF. Can you conceive naturally? Will IVF work if you have endometriosis? Will your ability to conceive be affected because of endometrial lesions?
Endometriosis creates a hostile environment for fertilization and also affects the subsequent implantation of the embryo in your uterus. When left unchecked, it may damage the eggs, block the tubes, form cysts, and change the pelvic environment which can gradually lead to infertility.
Depending upon your situation, your doctor may recommend surgery for endometriosis or IVF right away.
With the right IVF endometriosis protocol, careful monitoring, and the right timing, you have a fair chance of getting pregnant even when you have severe endometriosis.
The first step in IVF is to stimulate the ovaries for egg production. If endometriomas are present at that time, the response to this stimulation may be poor. Sometimes, egg quality is poor due to endometriosis and this results in low-quality embryos.
The endometrium in affected patients also has poor receptivity for embryo implantation.
Despite this, people with early treatment for endometriosis were found to have a conception rate of 64.40% through IVF, while untreated women had a success rate of 46.24%, according to a study of 330 participants (2).
Your doctor will do a laparoscopic surgical evaluation to determine the location and the stage of the disease you are at.
If you are at Stage I or II of endometriosis, you have a higher chance of both natural and in vitro fertilization (2). In fact, fertility is rarely impacted in Stage I and II endometriosis and you may be simply recommended medications, hormonal treatments, or intrauterine insemination. Many women even conceive naturally and the pregnancy is known to suppress the symptoms of endometriosis (as speculated to be the case of Queen Victoria).
Infertility is more common in women who are in advanced stages of endometriosis. With stage III or IV, there may be higher cancellation of IVF due to lower oocyte yield, interference of cysts, deeper scarring, and higher gonadotropin requirements (3).
But this doesn’t mean that it is impossible to get pregnant at these stages. IVF is one of the best solutions for Stage III and IV endometriosis.
In an observational study of 96 women who had endometriosis, the IVF success rate with stage III & IV endometriosis was 56.7%, while that with Stage I or II endometriosis was 67.7% (4).
Once your doctor has diagnosed your endometriosis and determined its severity, you will be recommended surgery, or IVF, or other ART procedures.
If you’re in advanced age or have poor egg quality because of endometriosis, you can also opt for IVF with donor eggs.
Endometriosis does not always cause infertility. When singer-songwriter Emma Bunton was diagnosed with Endometriosis in her early 20s, she was left heartbroken as doctors told her that she would probably never conceive. But with proper diagnosis and treatment, today Emma is a happy mother of two.
Pilates instructor Jessica Valant was diagnosed with endometriosis in 2005. In 2012, she was able to conceive her daughter naturally.
However, when she tried for a second baby, her endometriosis was back in full force with the fallopian tubes being blocked. This is when she decided to go for an IVF.
The first embryos failed to survive and the doctors told Jessica that she had poor egg quality. She was advised to get donor eggs, but she decided to give it another try. A few of her medications were changed to help improve the egg quality. The cycle of egg retrieval, sperm preparation, and egg fertilization was once again completed and the best-quality embryos were transferred and implanted. The implantation was ultimately successful and she gave birth to a healthy baby boy. She shared her inspiring story later on Youtube.
If there are large (lesions larger than 4 cm) and too many endometriomas, they would need to be surgically removed before IVF.
However, the excision of endometrial lesions from the ovaries can also diminish your ovarian reserve. This is especially true if you have bilateral endometriomas. In such cases, you might be recommended to skip the surgery and directly start the IVF treatment.
The following is a general IVF endometriosis protocol which may differ from case-to-case basis:
Treatment for endometriosis first and then IVF may be indicated only in certain circumstances or for women who:
- Have normal AMH (2-6ng/mol) levels in any phase of the cycle
- Have normal Antral Follicular Count (suggesting normal ovarian reserve)
- Fallopian tubes are clear
- Has a partner with a normal sperm count
- Are between their late 20s and early 30s
- Haven’t undergone surgery previously
- Experiencing rapid growth of lesions that are larger than 5 centimeters
IVF procedure may be directly considered if you have endometriosis along with:
- Poor ovarian reserve
- Low AMH levels
- Reoccurred endometriosis after surgery
- Damaged fallopian tubes
- Are older
- Partner with low sperm count
If excision surgery is performed, the best care should be taken to protect your ovarian reserve. For the best outcome, it is important to select your IVF clinic carefully.
The chances of post-operative pregnancy can be determined by calculating the ‘Endometriosis Fertility Index’ or the EFI score (5).
It is calculated by considering factors such as age, years of infertility, prior pregnancy status, etc. The higher the EFI score, the higher the chances of pregnancy postoperatively.
|9 -10||High chance of conceiving; start with timed intercourse|
|7 – 9||Good chances but may start with IVF|
|< 7||Low pregnancy rate|
However, a study of 133 participants found that the duration to natural conception after surgical removal of endometriosis was not much different in women with high or low EFI (6).
To get rid of the endometrial lesions and scar tissues, excision surgery may be done to enhance your chances of conceiving, to reduce the possibility of a miscarriage.
The surgery is done under general anesthesia and usually takes 30 minutes to up to 6 hours, depending on the severity of the case.
After this, you may be able to conceive naturally, with the assistance of hormonal treatments, or with the help of IVF. Optimal recovery post-surgery is the key to successful conception.
The best time to perform IVF after endometriosis surgery is between 7 months to 2 years, depending upon your recovery.
For women with endometriosis, the following factors need to be considered:
- Once the IVF process begins, the stimulation injections can cause estrogen to flare up. It is important to carefully monitor the symptoms at every step.
- Your doctor may prescribe specific drugs that prevent premature ovulation ahead of egg retrieval.
- As observed by Dr. Tomer Singer, MD, Certified Reproductive Endocrinologist, women with endometriosis usually need double the number of cycles for a successful IVF. This is often due to poor egg quality and may or may not apply to you.
According to a study published in Fertility and Sterility in 2016, 78 women who had severe endometriosis and had several failed IVF attempts underwent laparoscopic surgery (7), and 42% of these women delivered babies. 9% of those had conceived naturally, while others conceived through IVF.
With the right help, it should be possible to get pregnant even when you have severe endometriosis. You can consult with our fertility experts and start your process.
What you should know is that whether you get pregnant naturally or via IVF, endometriosis may persist, even though the symptoms may subside in the duration of your pregnancy. However, it may return and lesions can be reactivated after you deliver the baby. So, if you have endometriosis and are planning for a second child with IVF, you must undergo comprehensive treatment postpartum to reduce the risk of future infertility.
If you’re wondering if IVF will work if you have endometriosis, you should have a few tests done and consult with a fertility expert. Even if it is not straightforward, it may be certainly possible to conceive.
- Endometriosis: World Health Organization https://www.who.int/news-room/fact-sheets/detail/endometriosis
- Zhong, C., Gao, L., Shu, L., Hou, Z., Cai, L., Huang, J., Liu, J., Mao, Y., (2021, July 19). Analysis of IVF/ ICSI in Endometriosis Patients With Recurrent Implantation Failure: Influence on Cumulative Birth Rate. State Key Laboratory of Reproductive Medicine, Nanjing, China. Frontiers. https://www.frontiersin.org/articles/10.3389/fendo.2021.640288/full
- SonjaPop-Trajkovic, Jasmina Popović Vladimir Antić Dragana Radović Milan Stavanovic Predrag Vukomanović (2014), Stages of endometriosis: Does it affect in vitro fertilization outcome. Taiwanese Journal of Obstetrics and Gynecology. Vol. 53, Issue 2, June 2014, https://doi.org/10.1016/j.tjog.2013.10.040
- Paula Kuivasaari, Maritta Hippeläinen, Maarit Anttila, Seppo Heinonen, Effect of Endometriosis on IVF/ICSI Outcome: Stage III/IV endometriosis worsens cumulative pregnancy and live-born rates, Hum Reprod. 2005, Nov; 20 (11) 3130-5, DOI: 10.1093/humrep/dei176
- Zhou, Yong MD; Lin, Li MB; Chen, Zhengyun MD; Wang, Yuan MB; Chen, Chaolu MB; Li, Enchun MD; Wu, Ruijin MD∗. Fertility performance and the predictive value of the endometriosis fertility index staging system in women with recurrent endometriosis: A retrospective study. Medicine: September 2019 – Volume 98 – Issue 39 – p e16965 doi: 10.1097/MD.0000000000016965
- Hobo, R., Nakagawa, K., Usui, C., Sugiyama, R., Ino, N., Motoyama, H., Kuribayashi, Y., Inoue, M., & Sugiyama, R. (2018). The Endometriosis Fertility Index Is Useful for Predicting the Ability to Conceive without Assisted Reproductive Technology Treatment after Laparoscopic Surgery, Regardless of Endometriosis. Gynecologic and obstetric investigation, 83(5), 493–498. https://doi.org/10.1159/000480454
- David Soriano, Iris Adler, Jerome Bouaziz, Matti Zolti, Vered H Eisenberg, Mordechai Goldenberg, Daniel S Seidman, Shai E Elizur, Fertility Outcomes in Laparoscopic Treatment in Patients with Severe Endometriosis and Repeated in vitro Fertilization Failures, 106 (5): 1264-1269, October 2016, DOI: 10.1016/j.fertnstert.2016.06.003