There is no permanent treatment for endometriosis. All available endometriosis treatments, whether medical or surgical, are temporary, and endometriosis will inevitably return once treatment stops. This fact is probably best documented by the fact that pregnancy is considered to be the best treatment for endometriosis. Pregnancy, of course, stops all menstrual periods, and with it, the bleeding from endometriotic lesions. It, therefore, interrupts the process of endometriosis and alleviates symptoms.
Medications do the same. However, since those drugs also interrupt the menstrual cycles, for all practical purposes, they are contraceptives: an infertility patient who wants to conceive cannot be treated with such drugs for endometriosis. These medications are helpful only in clinically symptomatic patients, where pain management is the primary goal of treatment.
In such cases, endometriosis is also frequently treated surgically. As fertility specialists, we, however, are always concerned about the surgical treatment of endometriosis: especially if surgery involves the ovaries, we often see that such surgery ends up removing the last vestiges of functioning ovarian tissue, and puts the patient into outright menopause. There is a possibility that surgical removal of small, mild endometriosis may improve spontaneous pregnancy chances, but the time window is very short, and pregnancy success is likely much higher with IVF than with surgery. CHR, therefore, rarely recommends surgery for endometriosis before patients have completed their families.
What Are The Infertility Treatments for Women with Endometriosis?
As explained above, CHR physicians usually recommend IVF rather than surgery for women with endometriosis who want to get pregnant. With huge improvements in IVF pregnancy chances in the 30+ years since its inception, we no longer believe that surgery is the best option for endometriosis-induced infertility.
Treatment for endometriosis-related infertility requires a special expertise, and treatment must be individualized for each patient. For example, a patient whose endometriosis is causing infertility via malfunction of her fallopian tubes requires a completely different treatment approach from a patient whose endometriosis has invaded her ovaries and is affecting her ovarian reserve. For all women with endometriosis, however, infertility treatments should start as soon as possible, because nobody can predict how quickly the disease will progress.
The need for expertise and individualization go even further. For example, fertility treatments often involve increases in estrogen levels. Estrogen can "feed" endometriosis, and make it worse. Finding the right balance between advantages and risks of different infertility treatments, therefore, is always of utmost importance in providing fertility treatments to endometriosis.
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Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.