How Endometriosis Contributes to Infertility
How endometriosis leads to infertility: pathogenesis; effects on gametes, tubes, and endometrium; and treatments—expectant care, surgery, and ART.
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Evidence-based guidance on assisted reproduction for endometriosis—when to choose IVF, expected outcomes, protocol options, impacts on egg/embryo quality, and strategies to optimize success, safety, and time to pregnancy.
Overview
Assisted reproduction can be a strategic option when endometriosis affects fertility. IVF helps bypass pelvic inflammation, tubal scarring, or ovulatory disruption and can shorten time to pregnancy compared with expectant management or repeated IUI in many scenarios. Guidance focuses on choosing IVF versus surgery-first or combined pathways based on age, ovarian reserve, disease pattern, endometriomas, and male factor findings.
Content explains realistic success rates, egg and embryo quality considerations, and protocol choices that prioritize safety and pain control. Topics include antagonist or progestin‑primed stimulation, letrozole use, GnRH‑agonist triggers to limit OHSS, whether to remove endometriomas before retrieval, infection prevention, and when to choose freeze‑all, ICSI, or PGT‑A. For adenomyosis, practical pretreatment and transfer strategies to improve implantation are summarized and linked to Fertility Considerations. It also covers managing symptom flares during stimulation with support from Pain Relief. For workup and timing decisions see Infertility, and for surgical planning see Endometriomas and Excision Surgery.
When is IVF recommended for endometriosis?
IVF is typically favored when age or ovarian reserve suggests limited time, when disease is moderate–severe, tubes are blocked, IUI has failed, or there is coexisting male factor. If pain or organ compromise is the dominant issue, surgery may be prioritized first, then IVF as needed; decisions are individualized with data from Infertility and coordinated with Excision Surgery when appropriate.
Do endometriomas need to be removed before IVF?
Often no. Cystectomy can lower ovarian reserve, so surgery is usually reserved for cases with suspicious features, persistent pain, cysts larger than about 4–5 cm that obstruct retrieval, or repeated infections; see Endometriomas and Excision Surgery for detailed considerations.
Which ovarian stimulation protocols work best for endometriosis?
Many clinics use antagonist protocols with a GnRH‑agonist trigger to reduce OHSS and improve cycle control. Some add letrozole or use progestin‑primed stimulation to temper estrogen exposure, and a freeze‑all approach may be chosen if progesterone rises or endometrial conditions are suboptimal.
How does adenomyosis change the IVF plan?
Adenomyosis can reduce implantation and increase pregnancy complications, so pretreatment such as 2–3 months of GnRH‑agonist or continuous progestin and planning frozen transfers may improve outcomes. Personalization is key; see Fertility Considerations for adenomyosis‑specific guidance.
Are ICSI or PGT‑A recommended for endometriosis?
ICSI is not routinely required without male factor; while severe disease may slightly lower fertilization rates, many patients do well with standard insemination. PGT‑A can reduce time to a euploid transfer in older patients or those with recurrent loss, but it does not increase live birth for all age groups and is not a treatment for endometriosis itself.