IVF with Endometriosis: Everything You Need to Know
Endometriosis is a common cause of infertility in women. An estimated 30-50% of women with endometriosis have infertility, which is clinically defined as the inability to get pregnant after a year of regular unprotected sex. For those struggling with endometriosis and infertility, in vitro fertilization (IVF) can help. Endometriosis is responsible for at least 10% of indications for IVF.
What is Endometriosis?
Endometriosis is a condition that causes tissue similar to the uterine lining to grow outside the uterus. Endometriosis can grow on the ovaries, fallopian tubes, and pelvis. Endometriosis causes painful periods, painful sex, and chronic pelvic pain. And it can make getting pregnant challenging even when no other symptoms are present—a condition known in the world of fertility as “silent endo.”
IVF with Endometriosis: Enhancing Your Chances of Conception
Conceiving naturally with endometriosis can be challenging due to several factors. Endometriosis often causes scarring and inflammation of the fallopian tubes and ovaries, leading to decreased function.
Another challenge is the effect of endometriosis on ovarian reserve. Endometriosis can reduce the number of available eggs, and the inflammatory environment it creates may impair sperm function and fertilization.
As a result, while the natural conception rate is about 10-20% per month for those without endometriosis, it drops to 1-10% for those with the condition.
Diagnosing Endometriosis Prior to IVF
Diagnosing endometriosis typically requires a surgical procedure called laparoscopy, but non-invasive tests like ReceptivaDx can detect inflammation indicative of endometriosis.
Silent Endometriosis
Many individuals are unaware they have endometriosis until they experience infertility issues. This “silent endometriosis” often becomes apparent during fertility assessments.
Treatment Options: IVF for Endometriosis
One common question is whether to treat endometriosis or infertility first. For those aiming to conceive, IVF is a promising option, especially for advanced stages of endometriosis. Research indicates that surgical intervention before IVF does not necessarily improve outcomes for advanced endometriosis cases. Specialists often recommend proceeding directly with IVF for endometriosis in these scenarios.
However, for severe endometriosis symptoms or suspected cancer, surgery might be necessary before IVF. In such cases, fertility preservation techniques like egg freezing may be advised. For milder cases, surgery can improve spontaneous pregnancy rates, similar to the success rates of a single IVF cycle.
IVF Success Rates with Endometriosis
Though studies examining the rates of IVF success for women with endometriosis have found mixed results, the consensus is that IVF success rates for women with endometriosis vary according to the stage of the condition :
- Stage I or II Endometriosis: Approximately 67.7%
- Stage III or IV Endometriosis (Severe): Approximately 56.7% after 1-4 IVF cycles. Severe endometriosis tends to result in lower clinical and ongoing pregnancy rates per embryo transfer compared to those without the condition.
IVF Success Rates for Untreated vs Treated Endometriosis
For women with untreated endometriosis, one study found a live birth rate of 27.7%. In contrast, those who received treatment in the early stages had a live birth rate of 43.6%, and those in the later stages had a rate of 46.3%.
A meta-analysis of four studies comparing the reproductive outcomes in women with infertility and deep infiltrating endometriosis who received IVF with or without a previous surgery revealed that patients who had surgery before IVF had significantly higher pregnancy and live birth rates than those who did not. Specifically, the pregnancy rate per patient and per cycle was 1.84 times higher, and the live birth rate per patient was 2.22 times higher for operated patients.
Best IVF Protocols for Endometriosis
The most effective IVF protocols for women with endometriosis often involve a combination of treatment with medications and possible surgical procedures that are individualized to the individual stage and severity of endometriosis.
GnRH Antagonist Protocol
This protocol is gaining popularity due to its shorter duration and lower risk of ovarian hyperstimulation syndrome (OHSS). It involves the use of GnRH antagonists to prevent premature ovulation during ovarian stimulation. Some studies suggest this protocol may be beneficial for women with endometriosis.
Pretreatment with Hormone Therapy
Studies have shown that pre-IVF treatment with gonadotrophin-releasing hormone (GnRH) for 3-6 months significantly improves clinical pregnancy rates compared to those who do not receive this treatment. 5 .3
Aromatase Inhibitors
Using aromatase inhibitors like letrozole in combination with other hormonal treatments may help reduce estrogen production driving endometriosis, thereby reducing the size of endometriotic lesions while improving the ovarian response and oocyte production during IVF.
Frozen Embryo Transfer (FET)
For some women with endometriosis, performing a frozen embryo transfer (FET) in a subsequent cycle rather than a fresh transfer can improve implantation rates and pregnancy outcomes. This approach allows time for the endometrial environment to recover from the stimulation phase.
Surgical Treatment
Laparoscopic surgery to remove endometriotic lesions before starting IVF can improve pregnancy rates, especially in women with advanced stages of endometriosis.
Do IVF drugs make endometriosis worse?
It is possible that increased levels of estrogen due to medications used in IVF may temporarily worsen symptoms of endometriosis.
However, if endometriosis is known or suspected, part of that patient’s IVF protocol would be Orlissa or Lupron for 30-60 days to suppress endometriosis prior to stimulation.
Can IVF cause endometriosis?
No, IVF does not cause endometriosis. If not detected prior to IVF treatment, some medications may temporarily trigger symptoms of endometriosis. However, as we mentioned above, there are effective protocols for suppressing these symptoms.
How is the IVF process different for Endometriosis Patients?
IVF includes the following:
- Ovarian stimulation through medication
- Fertilization and embryo development in a lab
With endometriosis, the IVF process is the same as it would be for women without PCOS. The difference is the administration of Orlissa or Lupron 30-60 days prior to the start of an IVF cycle, and/or operative laparoscopy to remove endometriosis and scarring.
IVF with Endometriosis Success Stories
At CNY we’ve helped thousands of clients with endometriosis successfully grow their families. Here are just a few of our client success stories.
IVF with Endometriosis: The Takeaway
Endometriosis is a chronic condition that causes tissue similar to the uterine lining to grow outside the uterus, often resulting in pain and infertility. An estimated 30-50% of women with endometriosis face infertility. For those struggling with this condition, in vitro fertilization (IVF) can be an effective treatment.
While the natural conception rate for women with endometriosis is notably lower, IVF success rates vary by the severity of the condition. Protocols such as the GnRH antagonist protocol, pretreatment with hormone therapy, aromatase inhibitors, and frozen embryo transfer (FET) can enhance IVF outcomes.
Surgical intervention before IVF also shows promise in improving pregnancy and live birth rates. Despite potential complications, individualized IVF protocols offer hope for women with endometriosis to achieve successful pregnancies.
