Endometriosis

Endometriosis affects roughly 1 in 10 women of reproductive age. It is one of the more common things we find behind unexplained infertility. But having it doesn't automatically mean surgery is your next step. At TheFertilife, Dr. Anshika Lekhi looks at the whole picture first. How much pain you have, what your ovarian reserve is like, your age. Only then does she suggest medical treatment or surgery, or going straight to fertility treatment.

Book an Endometriosis Fertility Consultation - Call or WhatsApp +91 95600 26697. Speak directly with Dr. Lekhi's team to schedule.

"The question I get most often is 'should I have surgery first?' — and the honest answer is, it depends, in a way that genuinely surprises a lot of patients. Surgery can help, but for endometriomas specifically, it can also reduce your remaining egg count. That's not a reason to avoid surgery automatically, but it is a reason to make that decision deliberately, not reflexively." — Dr. Anshika Lekhi

How Does Endometriosis Affect Fertility?

Endometriosis is when tissue like the lining of the uterus starts growing anywhere outside the normal location. Usually it grows on the ovaries, the tubes,uterine muscles and the pelvic lining. It can hurt fertility in a few ways at once. 

There is inflammation, and that affects egg and embryo quality. There can be scar tissue that pulls the tubes and pelvis out of shape. And then there are the ovarian cysts called endometriomas, the "chocolate cysts", which press on healthy ovary tissue. It can even change the endometrial receptivity.

But here is the thing. Not every woman with endometriosis finds it hard to conceive. And how bad it looks on a scan doesn't always match how much it actually affects you.

Do I Need Surgery to Diagnose Endometriosis?

Not necessarily. This has actually shifted quite a bit from the older way of doing things. Earlier, laparoscopy was the only sure way to diagnose endometriosis. Now we rely a lot more on good imaging, like a transvaginal ultrasound or an MRI, to spot endometriomas and deep disease without operating. We keep laparoscopy for the cases where imaging isn't clear or where the treatment itself is going to need surgery anyway.

Should I Have Surgery Before Trying to Conceive?

This really depends on which type of endometriosis you have. Honestly, it is the most misunderstood part of the whole thing. Say you have mild disease, the superficial early-stage kind, and your ovarian reserve is good and nothing else is holding back your fertility. In that case, removing it surgically may give you a small bump in your chance of conceiving naturally.

Ovarian endometriomas are a different story. Surgery on these can actually lower your ovarian reserve afterwards. That risk is higher when the cysts are big, or keep coming back, or are on both sides. And the current guidance is clear here. Endometrioma surgery doesn't reliably improve IVF results. So if IVF is already your plan, there is no point doing it "just in case".

If the disease is more severe or deep, surgery is mostly to relieve pain. It won't do much for your natural conception odds, and IVF is usually the better route anyway.

When Is IVF Recommended Instead of Surgery?

For moderate to severe endometriosis, IVF is usually the more effective way to get pregnant. It simply bypasses the tubal and pelvic problems that endometriosis causes, instead of trying to fix them with surgery first. 

For milder disease, we sometimes try IUI with ovarian stimulation as a first step, as long as the ovarian reserve is good and there is no other infertility factor. For more advanced endometriosis though, IUI isn't usually the right call. 

One more thing. If you are young and looking at endometrioma surgery, do bring up egg freezing before you go ahead, because your ovarian reserve really can drop afterwards.

What About Hormonal Treatment for Pain?

Hormonal treatments like GnRH agonists work well for the pain of endometriosis. The catch is how they work. They suppress ovulation, so you can't use them while actively trying to conceive. 

We usually give them before fertility treatment begins, or after a cycle is done, or for long-term pain control when pregnancy isn't the immediate goal. We don't add them on top of an active fertility plan.

What Does Endometriosis Treatment Cost in Gurgaon?

The cost of endometriosis treatment depends on the severity of the condition and the type of treatment recommended. Here is a general estimate: 

Endometriosis severity and treatment response vary a lot between patients, and the surgery-versus-IVF decision depends on factors specific to your case. This page is informational and isn't a substitute for evaluation by Dr. Lekhi.