Implantation when you have endometriosis

[Skittles11]

Hi everyone - I really need your insights

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

[Jess1981]

Hi. In my case of fertility problems my endometriosis did impact implantation. But that was due to location my endometriosis grew ( on pouch of Douglas - a common place for endo to grow, uterosacral ligaments and bowel) My endometriosis made an hostile environment for any embryo to implant and uterus lining uneven. It can also bring inflammation which if it grows where mine is isn't the best to help conception . Since it was diagnosed and treated ( i ended up with 3 surgeries as it re grew after our first pregnancy which was a chemical but we still saw as huge progress of 6 years of no positive tests) We've conceived 6 times naturally but only have 2 live daughters. My endometriosis only showed on Laps but I never had MRI. Ultimately you must do what you feel is best but if it was me I want peace of mind knowing you have given it the best chance. My lap recoveries were straightforward and back to normal within 2 weeks ( my last lap was pretty extensive involving an endo specialist.) I would go with an endo specialist as it can get missed by general gynaecologist ( tho in my case my second fertility specialist was the one who did the first surgery and diagnosed it treating it all except the bowel - hence it re grew back rapidly and I was after my second surgery so much so I was referred to am endo specialist ) since have last surgery taken serreptase and this has improved my symptoms massively. I wish you the very best with whatever you decide 🤗

[DianeArnold Partner Nurse Fertility Network UK in reply to Jess1981]

Hi Jess. Lovely to see you here giving good advice. Hope you and your family are well. Diane

[Jess1981 in reply to DianeArnold]

We are good thank you. Time is flown by Francesca turned 4 in June and is now at school- she has also been diagnosed autistic ( at the moment non verbal) Eliza is now coming up 19 months and has definitely hit terrible 2s early 🤣 never a dull moment 🤣 But very grateful to have them and I remember very dark years where we generally believe we'd never have even just one . Thank you for all the helpful advice over the years. Xx

[Jess1981 in reply to Jess1981]

Also my endo specialist said he felt treating my endo would ease my pain and horrendous symptoms but couldn't promise it would improve my chances of conceiving ( but it did as I went on to fall another 5 times and had 2 live daughters) in my personal case if I had not had the surgery I would not have had my 2 daughters X

[Skittles11 in reply to Jess1981]

Thank you Jess. A specialist I spoke to said he would be more inclined to recommend a lap if I was trying naturally as it is thought to help, but as I'm going through IVF the advice seems less clear cut xx

[baubauwang in reply to Jess1981]

This is really helpful, as I am really struggling to make my mind to do surgery or not, thank you Jess for your sharing x

[Hidden]

So sorry to hear this. There are consensus statements based on research studies which say that if treating fertility alone there is no advantage to surgical management. If treating pain etc as well then that’s a different kettle of fish as you’re treating someone’s symptoms. But for success of assisted reproduction the evidence seems quite clear there is no benefit to surgery (there is improved natural conception rates soon after surgery though). Did the endometrioma only show on MRI and not USS?

[Skittles11 in reply to Hidden]

Hello

Thank you for this - yes my consultant was saying that if I had pain he would definitely be saying to have a lap but as I have little to no pain the situation is quite different.

The endometrioma has shown up in the past on Ultrasound and then at other times doctors have said it isn't there. I was getting fed up of all the mixed messaging, not knowing if it existed or not. The MRI has corroborated it is there but is small.

[Mcher]

Hello Skittles, Not sure if this is at sll helpful for your decision. I have terrible pain and 2 endomitriomas on my left ovary. I've never had an MRI or surgery to confirm how deep my endomitrios is (I also know pain is not always the indicator of how bad it is). I'm 32 and have had 1 egg collection. Got 8 embryos and 6 to freeze. Never tested the embryos but have done 5 transfers. I'm now 18 weeks pregnant (5th try). In a natural cycle 2/3 embryos implanted and had terrible results with the stimulated cycle. I'm not sure if the failed tries had anything to do with only implantation but the doctors think it could be the reason. But from research I've read the surgery does not guarantee a better result with IVF. Hard choice but I would recommend natural cycle as the estrogen did not do me any favours in the stimulerad cycle. Best of luck to you and sending baby dust x