Having endometriosis and conceiving can be a challenge is certain cases. Many people do not need in-vitro fertilization, but when the choice is made after other failed remedies, IVF can be a good choice. The IVF process differs with endometriosis. Prior to beginning ovarian stimulation with medications, a necessary step prior to egg retrieval, a laparoscopic excision of endometriosis or endometriomas (chocolate cysts), which are collections of blood inside the ovary, should be considered if the cysts are approximately three centimeters or greater.
Endometriomas can markedly distort the shape of the ovary and early intervention is always better.
During the stimulation portion of IVF, the higher levels of estrogen can cause endometriosis to flare up. This can result in pain. Patients with endometriosis also may need more the cycles to achieve pregnancy through IVF. This is often due to diminished egg quality. These patients need to be monitored a little more than the average patient since they may have a sudden dominate follicle appear and this can lead to all the other follicles lagging behind in their growth to become a mature follicle. We strive to have equal growth of all the follicles throughout the stimulation process which takes about 10 days.
Sometimes we use Letrozole, which lowers estrogen levels so the endometriosis implants are not stimulated which can cause the pain and inflammation. We also use Lupron which is known to reduce pelvic pain.
Since endometriosis does have an affect on egg quality overtime, we recommend freezing eggs at a younger age. Their future success if they do have to use IVF will be much higher then waiting.