With Advanced Endometriosis, Will I Only Get Pregnant Through IVF?

For many women with advanced endometriosis, “Will I only get pregnant through IVF?” is a prevalent worry and concern.

The dream of starting a family can feel out of reach, the prospect daunting, when you have advanced endo.

Conventional wisdom may suggest that IVF is the only option. But is this always the case?

Not necessarily.

If you have advanced endometriosis and want to get pregnant, you have options other than IVF.

But understand that every case of advanced endo is as unique as you are. And the only way to really explore the options available to you is to consult with a fertility and endo specialist.

What is Considered Advanced Endometriosis?

Advanced endometriosis is characterized by severe and dense pelvic adhesions, extensive and deep endometrial implants, and significant distortion of pelvic anatomy. It may involve organs such as the ovaries, fallopian tubes, uterus, and surrounding structures.

Advanced endometriosis often presents with severe pain, infertility, and other complications.

How does Advanced Endometriosis Affect Fertility?

Advanced endometriosis can profoundly impact fertility in various ways. For example:

• Structural Damage. Severe adhesions and scarring can distort pelvic anatomy, impairing the function of the reproductive organs and obstructing the passage of eggs and sperm.
• Ovulatory Dysfunction. Endometriomas (ovarian cysts) and hormonal imbalances associated with advanced endometriosis can disrupt normal ovulation, reducing the chances of conception.
• Inflammatory Environment. Chronic inflammation and immune system dysregulation can compromise egg quality, sperm function, and embryo development, hindering fertility.

Why Patients Seek Alternatives to IVF

In vitro fertilization (IVF) is a common fertility treatment for women with advanced endometriosis, but many patients look for alternatives for the following reasons:

• High Cost
• Potential Physical and Emotional Burden
• Risk of Multiple Pregnancies
• Risk of Ovarian Hyperstimulation Syndrome (OHSS)
• The Problem of Excess or Stored Embryos
• No Benefit For or Exacerbation Pain Symptoms

Options for Getting Pregnant with Advanced Endometriosis

While IVF is often recommended for women with advanced endometriosis, surgical  options can be considered and in certain situations

Optimal Excision by LAPEX Surgery

Optimal Excision LAPEX surgery can effectively remove endometrial lesions and adhesions, restoring pelvic anatomy and improving fertility outcomes.

Cystectomy for Large Endometriomas

Stimulation protocols required for IVF are often not recommended when a large (more than 3 cm) endometrioma is present.  Cystectomy (to remove the entire cyst wall) can be performed in most cases even for significant endometriomas, which can improve natural fertility, even if sometimes success by IVF is diminished.  

Bowel Endometriosis

Some patients will have advanced endometriosis involving the bowel and leading the bowel being distorted or adhered to the back of the uterus, sometimes called an obliterated-cul-de-sac.  In these cases, IVF is often recommended to bypass the issue.  However endometriosis involving the bowel can be removed, often requiring some form of bowel resection (removal of part of the bowel).  In such cases where bowel resection is needed, pregnancy rates do improved, and can be up to 60-70% still in 1-2 years after surgery.

Pelvic Adhesions

Pelvic adhesions can happen with advanced endometriosis, or after surgery for advanced endometriosis.  IVF is often recommended to bypass the problem, and to avoid surgery.  Surgery can be performed, usually in a minimally invasive fashion, to restore the anatomy, and 

Other Things to Think About When Trying to Get Pregnant with Advanced Endometriosis

In addition to actual treatment options, here are some other important considerations when you have advanced endometriosis and are trying to get pregnant:

• Individualized Approach. Each woman's journey with advanced endometriosis is unique, and treatment decisions should be personalized based on factors such as age, ovarian reserve, and overall health.
• Emotional Support. Coping with infertility due to advanced endometriosis can be challenging. So, seeking emotional support from loved ones, support groups, or mental health professionals is essential.
• Comprehensive Care. Partnering with a multidisciplinary team of specialists, including reproductive endocrinologists, fertility specialists, and pelvic surgeons, can ensure you have the comprehensive care and support you need throughout your fertility journey.

Schedule a Consultation with RESTORE Center for Endometriosis

If you're dealing with infertility due to advanced endometriosis, know that you're not alone.

Know, too, that IVF isn’t the only way to get pregnant or have a baby.

The caring and supportive staff at RESTORE Center for Endometriosis specializes in fertility and endometriosis treatment. Schedule a consultation today to explore your options to restore your reproductive health and your natural fertility.

Click here to schedule your consultation.