Endometriosis and endometrial pathology in IVF
Endometriosis and IVF
When endometriosis includes the fallopian tubes and ovaries, fertility is reduced. The basic mechanism by which endometriosis affects fertility is the formation of adhesions. The anatomy of the gynecological apparatus is modified by an important inflammation caused by this disease.
There are different forms of endometriosis. Peritoneal endometriosis is defined when only small peritoneal lesions are observed. Ovarian endometriosis is defined in the presence of endometriotic cysts on the ovaries. When endometriosis includes all the organs of the pelvic apparatus it is the most severe form called also frozen pelvis. In the latter case the nodules of endometriosis are observed which are inflammatory structures usually behind the uterus.
Ovarian and deep endometriosis must absolutely be operated. Peritoneal endometriosis is a subject of debate because according to some studies it does not affect fertility while according to other studies it must be operated and burned and immediately after seek pregnancy.
IVF vs surgery or both?
With regard to the peritoneal form and the ovarian form we recommend first of all surgery and then it is advisable to try spontaneously. In the case of deep endometriosis, it is recommended to switch to IVF after the operation.
Impact of endometriosis on IVF
Today it is considered that the presence of ovarian and deep endometriosis can alter the oocyte quality thus compromising the final outcome of ovarian stimulation.
Intra-uterine polypes and IVF
Intra-uterine polyps are related to infertility.
In addition, their presence increases the possibility of spontaneous abortion even after IVF. Endometrial polyps must always be removed.