Endometriosis is one of the commoner causes of difficulty in conceiving.

One of the difficult decisions many women face is whether to proceed with surgery first or preserve fertility before surgery.

Why surgery can affect ovarian reserve

Endometriotic cysts (“endometriomas”) can damage ovarian tissue directly. However, surgery can also reduce ovarian reserve because healthy ovarian tissue may be affected during cyst removal.

This is particularly important and relevant when:

  • If both ovaries are affected
  • If previous surgery has already happened
  • If AMH is already low

Why egg / embryo freezing may help

In some women, freezing eggs / embryos (if you have a partner) before surgery preserves fertility options before ovarian reserve potentially falls further.

If the endometriosis is significant, we don’t have a choice but to undergo surgery. However, it’s better if fertility preservation is discussed first.

IVF and endometriosis

Many women with endometriosis do conceive successfully with IVF.

However:

  • Response to stimulation can vary
  • Egg quality may be affected
  • Pelvic anatomy may be distorted making egg collections a bit tricky
  • Adenomyosis may coexist

Not every cyst needs immediate surgery

Many women assume every endometriosis cyst must be removed immediately.

In reality:

  • Some cysts can be monitored regularly whilst we are evaluating our fertility options
  • Some women may proceed directly to IVF
  • Some benefit from surgery first
  • Some benefit from egg freezing before surgery

The decision depends on symptoms, age, AMH, scan findings and future fertility plans.

The key message

The question is not simply: “How can I avoid surgery?”

The better question is: “If I need surgery, wow best can I time it so that my fertility options are optimised”

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