Endometriosis and infertility treatment

Excision or ablation of endometriosis plus adhesiolysis should be offered for endometriosis not involving the bowel, bladder or ureter, because this improves the chance of spontaneous pregnancy

Laparoscopic ovarian cystectomy with excision of the cyst wall, or laparoscopic drainage and ablation - should be offered to women or people with endometriomas, because this improves the chance of spontaneous pregnancy. Take into account:

• the possible impact on ovarian reserve
• that ablation and drainage may preserve ovarian reserve more than cystectomy

Discuss the benefits and risks of laparoscopic surgery as a treatment option with women or people who have deep endometriosis (including endometriosis that involves the bowel, bladder or ureter) and who are trying to conceive so they can make an informed decision on its use. Topics to discuss may include:

• possible impact of deep endometriosis on pregnancy outcomes
• whether laparoscopic surgery may alter the chance of future pregnancy
• possible impact on fertility if complications arise
• alternatives to surgery
• other fertility factors

Do not offer hormonal treatment alone or in combination with surgery to women or people with endometriosis who are trying to conceive, because it does not improve spontaneous pregnancy rates

Reference:

• NICE (April 2024). Endometriosis: diagnosis and management