Endometriosis is associated with an increased risk of having difficulty becoming pregnant, or infertility. Studies have shown that the amount of endometriosis that is seen at the time of laparoscopy is linked to future fertility.
There is a staging system for evaluating endometriosis:
Women with Stage I and II endometriosis may become pregnant on their own, however, medical studies do suggest that if laparoscopy is done in women who have infertility, they are more likely to have endometriosis than women who become pregnant with no difficulty. There is some evidence that pregnancy rates may improve if Stage I or II endometriosis is removed surgically, however some data shows that this does not help. In general, when women are young (less than 35 years old) it is reasonable to remove any visible endometriosis to see if pregnancy occurs. If women are 35 or older, other fertility treatments are recommended instead of laparoscopy (see below). If Stage III or IV endometriosis is present, pregnancy rates are higher after surgery is performed to remove scar tissue or large endometriotic cysts. If pregnancy does not occur within 6 months after surgical treatment of endometriosis, other fertility treatments should be discussed.
Unfortunately, some women with endometriosis can have cysts that come back. If cysts are removed over and over, this can cause a loss of eggs from the ovaries, and can make it harder to become pregnant.
Before starting any fertility treatment a complete fertility evaluation is performed. This can include hormone and other blood testing and checking the partner’s sperm count. Medical treatments depend on the stage of a patient's endometriosis:
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