There are many components to fertility that women might encounter with endometriosis. Some of these problems can be corrected by careful surgery.
These problems can be classified as ovarian (ovulation), tubal (infection, damage), uterine (polyps, fibroids) or inflammatory (endometriosis). A patient suffering from endometriosis will have a significant improvement in natural fertility by having all endometriosis lesions and associated scar tissue excised.
Fortunately, careful excisional surgery – a hallmark of surgery under the care of Dr Simon Gordon – can return a women’s fertility to that of an age-matched woman with an otherwise normal pelvis.
How does laparoscopic surgery improve fertility?
The average couple with normal fertility should conceive within approximately 6-9 months. For conception to occur one needs:
- normal sperm production
- timed intercourse at or near mid-cycle when ovulation is triggered
- patent and functioning Fallopian tubes to transfer the egg to the uterus (womb)
- normal endometrial lining to allow the zygote (fertilised egg) to attach.
Laparoscopy affords a “gold standard” opportunity to assess the patency of Fallopian tubes, as well as diagnosing the presence of pelvic endometriosis.
Patients with moderate to severe endometriosis will exhibit some of the classical symptoms of endometriosis. The overwhelming majority of patients with unexplained infertility, will on reflection have symptoms involving pelvic, period and ovulation pain.
Patients with endometriosis have reduced fertility, and therefore, removing all endometriosis restores fertility to near normal for any woman’s given age (not taking into account any male factors for infertility).
It is always the intention during a surgical procedure to safely and carefully remove ALL endometriosis deposits; in so doing, the negative influence of inflammation introduced into the uterus (via the patent Fallopian tubes) is removed or substantially reduced. Effectively, during surgery, patients with Stage 3 or 4 endometriosis are having the pelvic anatomy returned as close to normal.
Fertility rates with endometriosis
One of the real challenges for women is the fact that egg quality deteriorates with age. This decline in fertility is increased dramatically for women suffering from endometriosis.
Over the last 20+ years, Dr Gordon has had the pleasure of seeing many patients with severe bowel endometriosis conceive naturally once appropriate surgery has occurred.
| Age vs fertility % per cycle | Normal pelvis | With endometriosis |
|---|---|---|
| 20-35 | 25-28% | <5% |
| 36-40 | 15% | <2% |
| 41-43 | <10% | <1% |
| 44-45 | <5% | <0.5% |
How does Endometriosis affect fertility
Endometriosis can affect fertility in a number of ways:
- By creating a “hostile” environment in the pelvis, with inflammatory cells preventing embryo implantation even if the embryo is installed via IVF
- By damaging the tubal fimbria which allow the eggs to be transferred into the uterus for fertilization
- By adhesions which obstruct the fallopian tube
- By ovarian entrapment
The most common cause of infertility is due to the hostile environment.
By removing all active endometriosis, once new peritoneum has formed in the weeks after surgery natural fertility can occur. This has been evidenced in hundreds of patients over the last 20+ years as a specialist endometriosis surgeon.
What is the success rate of getting pregnant after laparoscopic surgery?
Patients with a normal pelvis after complete excision surgery (not just a few biopsies of lesions) will have a normal chance of conceiving naturally over the course of the next 12 months, all things being equal.
With over 20 years of experience, the earliest Dr Gordon has had a patient conceive naturally after complete excision of Stage 4 endometriosis is 5 weeks. Given that healing is still occurring within the first 8 weeks of surgery, this was a remarkable feat!
For those patients who have visited Endo Health, there is a large collage of photos from many patients who have been previously condemned as being infertile and have returned to normal fertility.
This poster is evidence that carefully orchestrated surgery by the experienced hand of Dr Gordon can and will return a woman to normal fertility.
