How does endometriosis surgery affect IVF outcomes?

This review looked at the effect of endometriosis surgery before in vitro fertilization (IVF). It found that surgery led to better pregnancy outcomes for patients with severe endometriosis.

Endometriosis is a condition in which cells from the lining of the uterus grow on the ovaries, Fallopian tubes, or other places in the abdomen. These lesions grow during each menstrual cycle and can cause abnormal pain and bleeding. Deep infiltrative endometriosis (DIE) is a severe form of endometriosis which may include lesions on the rectum or bladder.

Women with endometriosis have higher rates of infertility. In part, this is because lesions on the ovaries can reduce the ovarian reserve (the ability to produce eggs). Lesions on the bladder, rectum, and pelvis can also affect fertility. This may be due to inflammation, or because endometriosis can change the amount of the hormone progesterone. Women with DIE can undergo surgery to remove the endometriosis lesions in the abdomen.

Women with endometriosis and infertility are often treated with IVF. However, for women with DIE, it is not clear whether surgical removal of lesions before IVF leads to better fertility outcomes.

This review combined data from 4 studies of patients with DIE who were undergoing IVF. Patients and their doctors decided whether to have endometriosis surgery before IVF.

Patients who had surgery were 1.84 times more likely to become pregnant following IVF. Patients with surgery were also 2.22 times more likely to give birth to a live baby.

The researchers also looked specifically at patients with lesions on the rectum or colon. They found that patients with DIE of the digestive tract had 2.43 times higher odds of pregnancy after surgery. Patients with DIE without any digestive lesions also trended towards better pregnancy odds after surgery.

This review found that patients who had endometriosis surgery before IVF had better pregnancy outcomes.

The patients whose doctors recommended surgery may have had more treatable DIE.