Fertility and Endometriosis

[Skittles11]

Hi everyone - I really need your insights if you know about fertility and endometriosis

I've had an ongoing uncertainty around whether I have endometriosis ever since I started IVF treatment and now I am at a crossroads with it.

I had an MRI very recently which confirmed there is a small endometrioma on one ovary - approximately 1.8 cm. This confirms I do have endometriosis so at least I know now.

No adenomyosis (thankfully) was seen and no infiltrating deep endometriosis seen on MRI. However this doesn't mean it isn't there...

I am struggling with the decision about whether to have a laparoscopy.

I have little pain and will be using donor eggs in the future (one own embryo left then move to donor).

I know laparoscopy can affect egg reserve (if in ovary) however I won't be having more egg collections.

So the only reason to have this surgery in my case is if it is very likely to aid with implantation.

Is there any merit to having a laparoscopy to aid with implantation? Or not? My consultant was 50/50 about it and said both are valid, lap may not improve implantation but it might...

I don't know what to do. Any input greatly valued, via here of DM if preferred.

(Posting to Fertility and Endometriosis group, apologies for if you are seeing this message twice)

Thanks xx

[Honeybeehappy]

Hi there. It’s a difficult question and I think clinicians are on the fence about whether removing a small cyst will aid implantation. We did IVF for seven years and in that time, I had 2 surgeries to remove a massive endometrioma on my left ovary because it was interfering with egg collection. Obviously this was needed because we were using my own reserve at the time. Later, we moved to donor eggs and donor embryo and I had a few tiny simple cysts hanging around which wasn’t seen as an issue. One pregnancy led to early miscarriage but after about 12 transfers, none worked. I think non-implantation isn’t fully understood and it’s all a gamble at the end of the day. Even with endometrial scratches, different drugs, different doses - nothing worked. In amongst all that, I had a hydrosalpinx that I had removed because that does interfere with implantation due to toxic fluid (to the embryo) hanging about and I also got the tube clipped to stop it re-occurring. Remember that your endometrioma can get bigger over time. Over 4cm is usually when they’d look at taking it out. However, if you don’t have adenomyosis (which I do and is the reason we finally stopped treatment), and your cyst is small, I’m not sure surgery will enhance your chances. It might be worth discussing going on Prostap to quieten the ovaries and stop the cyst growing bigger between IVF cycles though - that’s chemical menopause and you might need add-back estrogen as it can have unpleasant side-effect. Good luck though! xx

[Skittles11 in reply to Honeybeehappy]

Thank you so much This is super helpful and I'm really grateful to you for sharing your experience and putting some things in to context to help me

I am so sorry to hear that you had 12 transfers and that none worked. You fought incredibly hard, I have had different battles (mainly in struggling to get embryos/ eggs in the first place) and it has been rough. I don't know how long ago your journey was but I hope you are happy or moving towards a more "comfortable" place.

At the moment I am thinking if is 50/50 then why put myself through surgery which is not guaranteed to help. It seems quite a big thing to go through especially considering little to no pain, the endometrioma is small and I'll be using donor eggs. Perhaps I'd need to look at it all again if donor eggs failed xx

[Honeybeehappy in reply to Skittles11]

Glad to help. 😁 We stopped treatment in 2019 and then went through massive efforts to adopt. I can only say that experience was worse than IVF because dealing with a dysfunctional system was much more harmful than playing with nature through medicine and I can’t say it’s recommended. We’re about to make a major complaint to be honest but that’s another story. Chat with your medical team and see what they’re thinking in terms of stopping the endometrioma growing and keeping an eye on your pelvis on general. My endometriomas were about the size of a large orange on both occasions and became painful and started twisting, taking me to A&E twice so it’s perhaps worth either doing watchful waiting or not allowing anything to get worse whilst your still doing IVF treatment. It’s worth knowing that the laparoscopy I had for the clipped tube and hydrosalpinx was really ok surgery-wise and I was back to normal within about a month in terms of full healing. It wasn’t difficult and was very straightforward - I was only in hospital overnight. You can sometimes get a really sore shoulder from the gas they put into your tummy to inflate the pelvic space. This just assists the surgeon with the procedure and the shoulder pain is just caused by the gas annoying your phrenic nerve but it goes away within a day or two. So whatever you choose, try not to worry if surgery is indeed recommended, and also don’t worry if you don’t go for surgery. In my own experience, nothing 100% guaranteed successful treatment cycles and all my surgeries were either necessary due to severe pain, or due to egg collection, or because there was firm evidence that surgery would improve our chances of implantation. xx