Fertility and endometriosis

Question 1

Ovarian supression (POP etc) to improve fertility

Answer 1

• No evidence for this before or after surgery
• Should not be done

Question 2

Surgery for endo and fertility (if not infertile)

Answer 2

Can improve spont preg:

• Excise mild to mod endo + adhesiolysis
• Consider CO2 laser vap
• Ovarian cystectomy for endometrioma - discuss possible loss of ovary
• If severe endo- discuss the location and if removal will improve chance of preg.

Question 3

If pt is infertile/male factor infertility

Answer 3

• Consider surgery for pain symptoms
• Might not improve spont preg outcome

Question 4

Other complementary rx

Answer 4

• Not recommended
• Eg Supplements, acupuncture, nerve blocks etc

Question 5

ART for endo + fertility

Answer 5

• If other rx have failed
• Male factor infertility
• Compromised tubal function
• Use controlled ovarian stimulation and IUI (better than IUI alone)

Question 6

Use of GnRH for fertility

Answer 6

• Can be used for 3-6 months before ART in infertile women

Question 7

Oocyte retrival w endometrioma

Answer 7

• Give abx
• Risk of ovarian abscess formation