In-vitro fertilisation (IVF) is another treatment that
can be used to help women become pregnant, especially
if the woman’s tubes are not functioning properly,
the partner is also infertile, or other treatments have
not been successful [7].
GnRH agonist pre-treatment
One well designed study indicates
that undergoing 3–6 months treatment with a GnRH
agonist before starting IVF increases the chances of
becoming pregnant fourfold. However, the authors of
the study stressed that more research is needed to confirm
this finding [9].
IVF treatment cycle
For information about in-vitro fertilisation
treatment, consult your local infertility treatment
centre.
Ovarian endometriomas
There is considerable debate about
how large ovarian endometriomas in women with endometriosis-related
infertility should be treated [7].
Leaving an ovarian endometrioma in
place does not seem to affect the success of IVF treatment.
Studies indicate that while surgery to remove the endometrioma
may result in fewer eggs being obtained during IVF,
it does not affect the resulting pregnancy rates [10,11,12].
Nevertheless, it is recommended that
you have a laparoscopy to remove any endometriomas greater
than 4 cm in diameter before starting IVF treatment
[7].
Removal of an ovarian endometrioma
allows the diagnosis of endometriosis to be confirmed
by a pathologist, and may reduce pain and discomfort.
It may also make the ovary more responsive to controlled
ovarian hyperstimulation, may make it easier for the
gynaecologist to collect the ovarian follicles [7],
may reduce the risk of infection following egg collection,
and may reduce the risk of contaminating the egg culture
medium.
However, removing the endometrioma
may also result in the removal of some of the adjacent
ovarian tissue, including some follicles (potential
eggs). This may lead to decreased functioning of the
ovary and occasionally even loss of ovarian function,
particularly in women who have had previous ovarian
surgeries [7].
Therefore, the decision to remove
an endometrioma must be carefully considered in the
light of your particular circumstances [7].
Success rates
The statistics on IVF pregnancy rates
are contradictory. One systematic review of research
studies indicates that IVF pregnancy rates in women
with endometriosis are about one-third lower than those
of women whose infertility is a result of tubal damage
[13]. However, some large databases of women undergoing
IVF treatment have found no differences in pregnancy
rates [14].
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