Endometriosis and Fertility — Integrated Reproductive Planning

Our approach to fertility-integrated care

Every endometriosis patient with current or future fertility goals receives an ovarian reserve assessment (AMH + antral follicle count) before any treatment decision is made. Surgical plans are calibrated to protect ovarian reserve. Where IVF is considered, we discuss timing relative to surgery in detail — sometimes IVF before surgery is the right answer, sometimes the opposite. The decision is individualised, not algorithmic.

Ovarian reserve in endometriosis

Endometriomas can reduce ovarian reserve directly. Surgical cystectomy can reduce it further. A clinical decision to operate on an endometrioma in a patient with already-reduced AMH requires explicit conversation about IVF first, fertility preservation, and the risk-benefit of conservative surgery versus IVF priority. Repeated ovarian surgery has cumulative impact and should be avoided where possible.

IVF vs surgery sequencing

For superficial endometriosis with infertility, evidence supports surgical excision over IVF as first-line in some scenarios. For deep infiltrating disease with severe pain, surgery may be the priority. For asymptomatic endometriomas in a patient already planning IVF, surgery before IVF is rarely the right call. The sequencing decision is one of the most consequential conversations in fertility-integrated endometriosis care.

Pregnancy outcomes

Endometriosis is associated with modestly increased risk of placenta-mediated pregnancy complications. Patients conceiving with endometriosis benefit from antenatal care that recognises this — not aggressive intervention, but appropriate monitoring at recognised checkpoints. Our integrated antenatal care pathway captures this.

Fertility-impact topics

Guidelines we follow

• ESHRE 2022 Guideline — fertility and endometriosis
• ASRM Practice Committee statements on endometriosis and fertility
• ESHRE Guideline on Ovarian Stimulation for IVF/ICSI

Where this fits

Fertility implications shape every treatment decision. For the IVF pathway itself, see IVF and reproductive medicine and specifically special cases including endometriosis.