Endometriosis , infertility, laparoscopic surgery and IVF.

Endometriosis is a very common finding in infertile women and is one of the most controversial topics. This is true for multiple reasons. For example, lots of patients with endometriosis have no symptoms at all, and this is an incidental finding either on a vaginal ultrasound scan, which picks up a chocolate cyst, or on a diagnostic laparoscopy done for checking infertility. Now, on an ultrasound scan or a laparoscopy, once the diagnosis is made, then doctors usually get itchy fingers and want to treat it. The treatment is usually doing an operative laparoscopy to remove the lesion, but whether this actually helps the patient is very controversial and the worry of causes that may actually reduce fertility because every time you remove normal ovarian tissue as well, whenever you're removing the endometriotic cyst.

Of course once the laparoscope is  already inside, most surgeons will go ahead and do the procedure anyway, but this is not always in the patient's best interest, especially for an asymptomatic patient where this is an incidental finding. Also, the treatment which is offered to the patient, to a large extent, depends on who makes the diagnosis of endometriosis 'cause if it's a gynecologist who does endoscopic surgery, then usually this is what the treatment will be offered because if you have a hammer in your hand, you look for nails. If, on the other hand, the diagnosis is made by an IVF specialist, then the patient is usually advised IVF, and that's why patient preference is so important, and the patient should decide "What's most important to me?"

Obviously, treating the endometriosis is never the endpoint. It's helping the patient to have a baby if she's infertile, which is what's important, or helping to treat her pelvic pain if that's what her major complaint is. That's why patients need to be extremely proactive and learn to make the right decision for themselves in partnership with their doctor so they don't reduce their chances of having a baby.

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