Endometriosis is one of the most common conditions among women undergoing IVF — affecting 25 to 50% of those presenting with infertility. Understanding how endometriosis specifically affects IVF outcomes, and what can be done to optimise them, is important for women planning assisted reproduction.

Dr. Shachi Singh, consultant gynaecologist and laparoscopic surgeon at Prakash Hospital, Sector 33, Noida, explains.

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How Endometriosis Impairs Fertility

Endometriosis reduces fertility through multiple mechanisms: the inflammatory pelvic environment impairs gamete function; endometriomas (ovarian chocolate cysts) damage surrounding ovarian cortex and reduce egg quality; adhesions distort pelvic anatomy; and impaired endometrial receptivity reduces implantation rates.

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Does Endometriosis Reduce IVF Success?

The data is nuanced

Stage I/II (mild/minimal) endometriosis: IVF outcomes in women with mild endometriosis are broadly comparable to tubal factor infertility — IVF success rates are not dramatically reduced.

Stage III/IV (severe) endometriosis with endometriomas: More significant impact. Women with endometriomas have lower antral follicle counts and lower egg numbers retrieved per stimulation cycle. The inflammatory environment of the endometrioma affects egg quality in surrounding follicles.

Endometriomas and ovarian reserve: The endometrioma itself is damaging — it produces reactive oxygen species that damage adjacent follicles. Surgery to remove endometriomas carries a risk of further reducing ovarian reserve (removing some healthy ovarian cortex inadvertently). The decision whether to operate before IVF requires careful weighing of these competing risks.

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Should Endometriomas Be Removed Before IVF?

This is one of the most debated questions in reproductive medicine. Current evidence suggests:

• Endometriomas below 3 to 4 cm generally do not need to be removed before IVF — the surgical risk to ovarian reserve may outweigh the benefit
• Large endometriomas (above 4 cm) may benefit from surgical removal before IVF, particularly if they are reducing access to follicles for egg retrieval, or if the woman has already had adequate egg numbers in previous cycles
• Women with bilateral endometriomas and already reduced AMH should be particularly cautious about bilateral surgery — the risk of significantly worsening an already limited reserve is real

The general principle: In women with good ovarian reserve, surgery before IVF may optimise egg quality and pelvic environment. In women with already reduced reserve, the risk of further reducing reserve with surgery may make proceeding directly to IVF the wiser choice.

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Optimising IVF in Endometriosis

• Careful individualised stimulation protocols
• Down-regulation with GnRH agonist for 2 to 3 months before IVF stimulation — reduces inflammatory environment and may improve egg quality and implantation rates
• Embryo quality assessment — selecting the best blastocyst
• Frozen embryo transfer (FET) in an optimised endometrial environment often preferred over fresh transfer in endometriosis

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Fertility Care in Noida and Greater Noida

Dr. Shachi Singh at Prakash Hospital, Sector 33, Noida, provides integrated endometriosis and fertility care for women across Noida and Greater Noida.

To book a consultation with Dr. Shachi Singh, call: +91 97023 46853

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This blog is for informational purposes only.