Does fertility treatment exacerbate endometriosis?

From the Guidelines

Fertility treatments do not exacerbate endometriosis and may even provide temporary relief from symptoms in some women. The relationship between fertility treatment and endometriosis is complex, and some fertility medications like gonadotropins used during ovarian stimulation for IVF may temporarily increase estrogen levels, which could theoretically exacerbate endometriosis symptoms in some women 1. However, many fertility treatments actually help manage endometriosis. GnRH agonists (like leuprolide acetate) and oral contraceptives are often used both to treat endometriosis and as part of fertility protocols, suppressing ovarian function and reducing estrogen, which can decrease endometriosis-related inflammation and pain 1.

Key Considerations

• Fertility treatments can help manage endometriosis symptoms in some women
• GnRH agonists and oral contraceptives are used to treat endometriosis and as part of fertility protocols
• Pregnancy itself often provides temporary relief from endometriosis symptoms due to hormonal changes
• Individualized plans are created to balance effective treatment with minimizing disease progression

Treatment Approaches

• Surgical removal of endometriosis lesions before fertility treatment may be recommended in some cases
• Proceeding directly to IVF may be suggested depending on the severity of the condition and other factors
• Expanded protocol transvaginal ultrasound (TVUS) studies and MRI protocols tailored for detection of deep endometriosis (DE) can help inform patient decision making and surgical planning 1

Evidence-Based Recommendations

• The most recent and highest quality study suggests that fertility treatments do not worsen endometriosis 1
• Medical therapies, such as GnRH agonists and oral contraceptives, can help manage endometriosis symptoms
• Surgical excision by a specialist is considered the definitive treatment for endometriosis 1

From the Research

Fertility Treatment and Endometriosis

• The relationship between fertility treatment and endometriosis is complex, with some studies suggesting that surgery for endometriosis can have a beneficial impact on the chance of spontaneous conception 2.
• However, selecting the appropriate surgical candidate can be challenging, and first-line-assisted reproductive technology (ART) is generally preferred over surgery for patients with endometriosis-related infertility 2.
• Fertility preservation techniques, such as embryo, oocyte, and ovarian tissue cryopreservation, may be proposed for patients with endometriosis, particularly those at risk of decreased ovarian reserve or bilateral ovarian injury 3, 4.

Risks and Benefits of Fertility Treatment for Endometriosis

• Surgery for endometriosis may have risks, including damage to ovarian reserve, adhesions, and surgical complications, which should be carefully considered when deciding on a treatment plan 2.
• Medical therapy, such as non-steroidal anti-inflammatory drugs (NSAIDs), combined oral contraceptives (COCs), and progestins, may be effective in relieving symptoms of endometriosis, but may not necessarily improve fertility 5.
• Gonadotropin-releasing hormone (GnRH) agonists and antagonists may be used as second-line therapy for endometriosis, but their use should be carefully considered due to potential side effects and limited long-term efficacy data 5.

Fertility Preservation Options for Women with Endometriosis

• Oocyte cryopreservation may be a viable option for women with endometriosis, with reported cumulative live-birth rates of 46.4% in one large series 3.
• Embryo cryopreservation and ovarian tissue cryopreservation may also be considered, although more data are needed to fully understand their effectiveness and risks in women with endometriosis 3, 4.
• Fertility preservation should be considered on an individual basis, taking into account the patient's fertility goals, disease severity, and overall health status 4.