Diagnosis & Therapy

Infertility in Endometriosis

After surgical treatment for endometriosis, how do you decide between the chance of spontaneous pregnancy vs the need for IVF?


For many women, one of the most troublesome aspects of endometriosis is infertility. Although a causal relationship between the two has not been identified, data suggest that up to 50% of women who have endometriosis are infertile.1

The management of endometriosis while preserving or augmenting fertility is one of the most challenging clinical enterprises encountered by gynecologists. Ovarian endometriomas have been shown to have an adverse impact on ovulation rates, markers of ovarian reserve, and response to ovarian stimulation.2 Surgical intervention is an effective means of eradicating lesions and treating the chronic pain that is often associated with endometriosis; however, decreased ovarian reserve following surgery can be problematic.

Whether or not to proceed to in vitro fertilization (IVF) following surgical treatment for endometriosis is a complex decision and will vary from patient to patient given the heterogeneity of the disease. Tommaso Falcone, Professor and Chair of Obstetrics and Gynecology at the Cleveland Clinic in Cleveland, Ohio, shares his insights on the importance of individualizing care and assessing the need for IVF following the surgical treatment for endometriosis.


Perspectives on Endometriosis Management

Mechanical stripping of the cyst wall during laparoscopic cystectomy

In the setting of advanced disease with severe adhesions the chances of spontaneous pregnancy are low, even following surgical intervention. Advanced cases of endometriosis are characterized by severe adhesive disease, which poses an obvious impairment to fertility by diminishing tubo-ovarian motility, thereby impeding pick-up function.3 Additionally, recurrence of adhesions and pain is likely. In this setting, IVF is a valuable tool.

Kathleen Krafton is a freelance medical writer for OBG Management.

Tommaso Falcone reports no conflicts of interest related to this article.


1. Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol. 2004;160(8):784-796.
2. Shah DK. Diminished ovarian reserve and endometriosis: insult upon injury. Semin Reprod Med. 2013;31(2):144-149.
3. Falcone T, Lebovic DI. Clinical management of endometriosis. Obstet Gynecol.2011;118(3):691-705.

Adhesive endometriosis