Medical Health Encyclopedia

Once careful instruction is given for all the risks and benefits of the different surgical options, the physician must then respect any decision a patient makes to retain as much of her reproductive system as she wants, even if she is past menopause. Both the patient and the physician should also be clear about the possibility of changing procedures once the operation has begun, depending on what the surgeon may observe. For example, the surgeon may find abnormalities that require more extensive surgery.

Much of the success of any procedure relies on the experience of the surgeon. A woman should always ask for a doctor's track record, or the number of times he or she has performed the procedure in question. The more, the better. Asking for complication rates may be helpful, but a patient should realize that an experienced surgeon may have a higher number of high-risk patients, and therefore, a higher complication rate than a less experienced surgeon with fewer serious cases.

Treating Infertility in Patients with Endometriosis

For women with severe endometriosis who want to become pregnant, conservative surgery (typically laparoscopy) is the appropriate approach for restoring fertility.Hormonal therapies, such as GnRH agonist or progestins, used to treat endometriosis itself have no affect on fertility. Of interest, however, was a 2002 study suggesting that the use of the GnRH agonists after surgery helped improve conception rates in women who subsequently undergo assisted reproductive techniques (ART), such as in vitro fertilization (IVF).

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In any case, ART or hyperstimulation of the ovary using fertility drugs to produce eggs are the standard fertility treatments available to women if surgery fails. Hyperstimulation is the less expensive approach, but in a 2003 study, ART achieved much greater conception rates in women with endometriosis, particularly those with late-stage disease. Prolonged use of fertility drugs in hyperstimulation can also have adverse effects on the uterus. Some experts point out, however, that there were no data in the study to compare the number of successful deliveries using the two approaches.

Of note, it is not clear whether women with early-stage endometriosis do any better with fertility treatment than simply trying to become pregnant through non-aggressive means.