Endometriosis & Fertility
Timing and Choices Matter.
Endometriosis affects up to 30-50% of women with infertility. The right strategy — surgery first, IVF first, or both — depends on your age, ovarian reserve, severity, and pain burden. Most patients are not counselled on this honestly.
The Surgery vs IVF Question
There is no universal answer. For young patients with painful endometriosis and adequate ovarian reserve, surgery first may improve natural conception. For women >35 with low AMH, IVF often takes priority — and surgery, if done, must be conservative to preserve eggs. We discuss the trade-offs explicitly.
Key Points
- Comprehensive ovarian reserve testing (AMH, AFC) before any surgical decision
- Endometrioma surgery only when truly indicated — cystectomy reduces ovarian reserve
- Endometriosis Fertility Index (EFI) used for prognosis
- IVF protocol adjustments for endometriosis (long agonist, freeze-all where indicated)
- Pre-IVF surgical clearance only when symptom burden or surgical pathology warrants
- Fertility preservation discussed when ovarian reserve is at risk
Dr. Priyadatt Patel
Senior Gynecologist · IVF Specialist · Advanced Laparoscopic Surgeon · Endometriosis Expert
“For endometriosis fertility, the wrong surgery is worse than no surgery. The right surgery, timed correctly, is sometimes the single best fertility intervention. Knowing which is which is the entire skill.”