Does Endometriosis Surgery Increase Fertility?

Does Endometriosis Surgery Increase Fertility?

We know that the presence of endometriosis negatively affects fertility, there is not much discussion about this. But should surgery be performed to increase fertility ❓ Or does the surgery we will perform on a patient diagnosed with endometriosis also increase the fertility of this patient ❓ Here I took a look at a review article published in a prestigious journal (BMJ-November 2022)that has just come out of the oven to answer this difficult question.

There are studies showing that performing surgery on the superficial form of endometriosis increases pregnancy rates. But there is NOT yet a randomized controlled, in other words, a strong study investigating the effect of performing surgery in the presence of deep endometriosis or a chocolate cyst. In other words, it is not the right approach to say to a patient who has never been able to get pregnant due to endometriosis, “let's remove your chocolate cysts, then you will DEFINITELY get pregnant”. As it can be seen, even in the most up-to-date article on the subject, a very, very important question could not be answered clearly.

So what am I doing in my own practice❓ 1️⃣I recommend surgery to patients who have no expectation of children, have completed their fertility, despite drug treatments, have not passed the pain associated with endometriosis and whose life has become unbearable due to these pains. The aim here is to ensure that the patient's pain passes and to provide him with a better quality of life. 2️⃣If the patient does not have much pain, has chocolate cysts and cannot get pregnant, I recommend the use of assisted reproductive techniques (IVF-vaccination, etc.) to these patients. I'm not in this part of the business, I refer patients to my colleagues who are engaged in this business. 3️️The patient is very painful, and these pains are not only unbearable, but the patient also has an expectation of fertility. The drugs are not helping. By talking to this group of patients in detail, we are planning a surgery together with them. The aim is to reduce the pain as much as possible and, in doing so, not to harm the patient's fertility. In this case, our main enemy and target becomes deep foci of endometriosis, which are the real cause of pain, not chocolate cysts.

Assoc. Dr. Doğukan YILDIRIM

İstanbul Alle Sağlık Merkezinde Jinekolojik Onkoloji uzmanı olarak hizmet veren Dr. YILDIRIM, başarılı ameliyatlarıyla tanınmakta olup poliklinik hizmetlerine aralıksız devam etmektedir.