Endometriosis and IVF: Your Path to Parenthood

Living with endometriosis is challenging enough without fertility struggles on top. If you're facing both, here's what you need to hear: IVF offers a real, evidence-backed path to parenthood for endometriosis patients.

While endometriosis can make conception more difficult, IVF essentially bypasses many of the obstacles it creates—damaged tubes, pelvic adhesions, and altered egg transport. Let's explore what the research shows and how to maximize your chances.

How Endometriosis Affects Fertility

Understanding the mechanisms helps explain why IVF is so effective:

• Pelvic adhesions: Scar tissue can block or damage fallopian tubes—IVF bypasses tubes entirely
• Chronic inflammation: The inflammatory environment can impair natural conception—but not IVF fertilization in the lab
• Reduced ovarian reserve: Endometriomas and surgery can decrease egg supply—but you only need a few good eggs for IVF
• Implantation issues: Some evidence of altered receptivity—addressed through careful protocol selection

IVF Success Rates by Endometriosis Stage

Endometriosis is classified into four stages based on severity. Here's what research shows about IVF success:

Live birth rates per cycle, women under 38. Individual results vary based on age, ovarian reserve, and other factors.

Endometriomas: Should You Have Surgery First?

This is one of the most common questions—and the answer may surprise you. For most patients considering IVF, surgery to remove endometriomas is NOT recommended.

Here's what multiple meta-analyses show:

• Surgery does NOT improve IVF outcomes for endometriomas
• Surgery reduces ovarian reserve—AMH drops 30-50% after cystectomy
• Repeat surgery is worse—each procedure removes more healthy tissue
• Bilateral surgery is particularly damaging to reserve

What About Deep Infiltrating Endometriosis?

Deep infiltrating endometriosis (DIE) is more complex. Some studies suggest surgery may help before IVF, while others show no benefit. Consider surgery if:

• You have significant pain symptoms requiring relief
• DIE is affecting bowel or bladder function
• Your surgeon is highly experienced in DIE excision

For asymptomatic DIE discovered incidentally, proceeding directly to IVF is often the better choice.

Adenomyosis: The Often-Overlooked Factor

Adenomyosis (endometrial tissue growing into the uterine muscle) frequently coexists with endometriosis and can impact IVF outcomes more significantly:

Data from 2024 Taiwan study of 1,389 FET cycles

If you have adenomyosis, don't despair—these are first-cycle rates. Cumulative success across multiple cycles remains meaningful, and treatment protocols can help.

The Power of Pre-IVF Treatment

Here's genuinely exciting news: treating endometriosis before starting IVF significantly improves outcomes:

What Does Pre-Treatment Look Like?

• GnRH agonist suppression: 2-3 months of medications like Lupron to suppress endometriosis activity before stimulation
• Birth control pills: Sometimes used for 1-2 months to quiet the disease
• Treatment of chronic endometritis: Antibiotics if uterine inflammation is present

This pre-treatment appears to create a more favorable environment for both stimulation and implantation. Even patients who start treatment only after initial IVF failures see improved outcomes.

Optimal IVF Protocol for Endometriosis

Why Frozen Transfer May Be Better

For endometriosis patients, frozen embryo transfer (FET) offers several advantages:

• Lower ectopic pregnancy risk compared to fresh transfer
• Natural or medicated cycle creates calmer uterine environment
• Time for pre-transfer suppression if beneficial
• Better endometrial receptivity without stimulation hormones

Many clinics now recommend freeze-all for endometriosis patients as standard practice.

Egg Quality: The Good News

A common worry is that endometriosis damages egg quality. Research suggests the impact is quantitative rather than qualitative:

• You may produce fewer eggs (especially with endometriomas)
• But the eggs you do produce have similar quality potential
• Per-embryo pregnancy rates are comparable once you have embryos

Think of it this way: endometriosis may affect how many eggs you retrieve, but not necessarily how good those eggs are. Quality embryos from endometriosis patients implant just as well.

What If One Ovary Is Affected?

Good news here too. Research shows that in patients with unilateral endometrioma:

• The affected and healthy ovaries produce similar numbers of oocytes
• Egg quality is similar between ovaries
• IVF outcomes are comparable to patients without endometriomas

Your "good" ovary can do the heavy lifting, and your affected ovary may still contribute.

Multiple Cycles: The Cumulative Picture

Here's something the first-cycle statistics don't show: cumulative success across multiple attempts:

Even with challenging diagnoses, the majority of patients under 38 achieve live birth within three IVF cycles. Persistence and proper protocol pay off.

Lifestyle & Supportive Care

Anti-Inflammatory Approach

Endometriosis is an inflammatory condition. Supporting your body with anti-inflammatory strategies makes sense:

• Mediterranean-style diet: Rich in vegetables, olive oil, fish, nuts
• Limit red meat and processed foods: Associated with worse endo symptoms
• Omega-3 fatty acids: Fish oil, walnuts, flaxseed
• Antioxidants: Colorful fruits and vegetables

Supplements to Consider

• Vitamin D: Often low in endo patients; test and optimize
• Omega-3s: 1-2g daily for anti-inflammatory effect
• NAC (N-acetyl cysteine): Some evidence for endo symptom improvement
• CoQ10: Standard egg quality support

Pain Management During IVF

If you're managing endo pain during your cycle:

• Avoid NSAIDs (ibuprofen, naproxen) during stimulation and after transfer
• Tylenol is safe for pain relief
• Heat therapy for comfort (not after embryo transfer)
• Talk to your RE about any prescription pain medications

When to Consider Donor Eggs

For some endometriosis patients, donor eggs may become the best path forward. Consider this option if:

• Multiple surgeries have severely depleted ovarian reserve
• You're over 40 with diminished reserve
• Multiple IVF cycles with own eggs have failed
• AMH is very low with poor response to stimulation

The good news: your uterus can absolutely carry a pregnancy, even with adenomyosis. Donor egg success rates are excellent across recipient ages.

Questions for Your RE

When consulting about endometriosis and IVF:

• "Do you recommend surgery before IVF given my specific situation?"
• "Would pre-treatment suppression benefit me?"
• "Do you recommend fresh or frozen transfer for endo patients?"
• "How does my endometrioma size affect your approach?"
• "Should I be tested for adenomyosis?"
• "What's your experience with endo patients and typical outcomes?"

Endometriosis IVF in Colombia

Colombian fertility clinics have extensive experience treating endometriosis patients with modern, evidence-based protocols:

• Careful pre-cycle evaluation with ultrasound assessment
• Protocol customization based on your specific presentation
• Freeze-all capability when optimal
• Experienced surgeons if intervention is truly needed
• Significant cost savings—important when multiple cycles may be needed

Hope Is Warranted

If you've been struggling with endometriosis and infertility, IVF offers a genuine path forward. The key points to remember:

• IVF bypasses many endo-related barriers
• Success rates are encouraging, especially for Stage I/II
• Think twice about surgery—it often doesn't help and may hurt
• Pre-treatment can significantly improve outcomes
• Frozen transfer is often the better choice
• Cumulative success across cycles is meaningful

Your diagnosis is a challenge, not a verdict. With the right team and approach, motherhood is absolutely within reach. 💜