Approximately 1 in 10 women worldwide suffer from Endometriosis, and it is one of the leading causes of infertility, especially in the Western world.

What is Endometriosis?

In simple words, Endometriosis is the presence of the lining of the uterus (Endometrium - that sheds when you get a period) in places it isn't supposed to be. Even though common sites for endometriosis are the ovaries, pelvis, tubes, endometriosis has even been diagnosed in the lungs, surgical scars, etc.

What does it mean? 

It means that every time you get a period, and the lining of your uterus sheds to make you bleed, the endometriosis will also bleed wherever it may be in your body. BUT it will not have an escape route like your period. This can make your period extremely painful. Besides pain, Endometriosis can cause infertility through various mechanisms, such as by affecting the quality of the eggs, scarring the tubes, distorting the pelvis, etc. 

Ovarian Endometriosis: Endometriosis in the ovaries can cause cysts called ENDOMETRIOMAS. Even though these could be the cause of excruciating pain for which one seeks an ultrasound and diagnosis, often they are diagnosed coincidentally during a routine infertility workup. This makes surgery a difficult decision in case you are on your way to an IVF cycle.

The topic of removal of Endometriomas is clouded with controversy. Besides the risk of surgery, one of the main concerns is what happens to the ovarian reserve (quantity of eggs) after the cyst is removed. Endometriomas are extremely clingy to the ovarian tissue that contains eggs. It is not uncommon to damage a part of that ovary while excising the cyst, even with the best set of surgical hands. This can make the surgery counter productive if your goal is to get pregnant.

However, here are some reasons why you should still consider surgery before your IVF cycle:

1. If you have very painful periods

2. If there is a suspicion that the cyst could be malignant

3. If the cyst is large enough to obstruct removal of eggs during IVF

4. If you need Laparoscopy for any other problemEither way, you need to discuss the pros and cons of the surgery with your doctor in detail, and make an informed decision for yourself!