2026, Responses from Fertility and Gynaecology Specialist, Dr Simon McDowell
“How does endometriosis affect IVF success?”
For people with proven endometriosis, IVF success rates tend to be lower. This is true whether or not the disease has been treated. It is thought that endometriosis may reduce egg supply, and there is also a possibility it could affect embryo implantation, though this is unproven.
Surgery can be helpful in some situations, but it is not always recommended. For example:
- Surgery may be avoided if it could further reduce egg supply.
- Surgery may be considered when symptoms are significant.
Summary: Endometriosis can negatively affect IVF success rates, although the degree varies between individuals.
“I have been told I have deep infiltrating endometriosis (DIE) after an early pregnancy ultrasound. Our fertility specialist advised continuing with IVF but is there anything else that can be investigated or treated to prevent it from affecting IVF or natural conception?”
This is a complex issue and requires specialist assessment. Factors to consider when exploring options include:
- The severity of symptoms.
- Female age.
- Duration of trying to conceive.
- Previous IVF treatments and number of embryo transfers.
- Efforts at natural conception and how long they have been ongoing.
“Is there any evidence that repeat surgery improves outcomes for someone with endometriosis or adenomyosis after several unsuccessful IVF cycles?”
There is no strong evidence to support repeat surgery in this context. High-quality trials specifically addressing this question do not exist.
Surgery is not routinely recommended for repeated IVF failure. However, it may be considered depending on:
- Symptoms
- Age
- Previous IVF outcomes
The decision would be discussed on a case-by-case basis rather than applied automatically.
“What is the best pathway to being considered for surgery to improve quality of life after successful fertility treatment?”
The best pathway will depend on each person’s individual situation. Factors that need to be considered include their symptoms, any previous treatments they have had, and their goals for the future.
For people experiencing heavy or problematic bleeding, a Mirena may help reduce the amount of bleeding.
For some people who have completed their family, a hysterectomy may be an appropriate option. If a hysterectomy is performed, the aim would also be to remove any other visible endometriosis at the same time.
Other treatment options may include:
- Suppression of the ovaries to help manage symptoms.
- Treatment with a pelvic floor physiotherapist.
- Using certain neuromodulating agents if pain is more complex or long-term (chronic).
In summary: There is no single pathway that suits everyone. The most appropriate treatment plan should be tailored to the individual’s symptoms, treatment history, and personal circumstances.