I’m 33years old. I was diagnosed with stage 1 endometriosis via laparoscopy in 2021 when doing fertility treatments. My symptoms were/are infertility, pain with sex, and painful periods. The endometriosis was treated only with ablation and I noticed no change with any of my pain after and my fertility treatments (2 egg retrievals- very poor egg quality and 2 transfers- one miscarriage and one failed implantation) were unsuccessful. My day to day/period pain is tolerable, and the pain with sex can be managed with accommodations, but at times the symptoms seem to be worsening. We still desire kids but aren’t currently pursuing any fertility treatments and are very much on the fence about doing more in the future, due to the previous poor outcomes. I’m concerned about the potential for disease progression, but because my current symptoms are manageable and I only had stage 1 endo at my last surgery, I’m wondering if I should consider another surgery now, this time with excision done by an endometriosis specialist, before my symptoms worsen, or if I should wait until my symptoms become more severe? I’m also concerned that because my first surgeon was not an endo specialist and only did ablation that some disease was missed or not treated appropriately. Would it be an overreaction to reevaluate it, even though my daily physical symptoms are manageable? Is it worth considering from a fertility point of view?
Endometriosis
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December 23, 2024
Hello,
Thank you for your question. I think this is a very interesting case, and there are several important points we should address from your story — mainly two aspects that are crucial in endometriosis patient care.
First, I would like to address the question of the stage of your endometriosis. Even though your symptoms could indeed appear at different stages, including stage I, the first step I would recommend is proper mapping of the disease via transvaginal sonography or MRI, ideally performed by an endometriosis specialist. You mentioned that you were not treated by an endometriosis specialist, which is why reassessment is important.
As you may have noticed, I did not include laparoscopy as an assessment tool. In most cases, endometriosis can be accurately mapped using imaging, and laparoscopy is rarely necessary for diagnosis alone. Unfortunately, endometriosis can easily be missed during laparoscopy performed by a non-specialist. Based on your symptoms, I would suspect that there may be more disease present.
Regarding surgical treatment, I believe you would definitely benefit from expert endometriosis excision surgery. Waiting for symptoms to worsen is never a good idea. Chronic pain becomes significantly more difficult to treat, often requiring multimodal therapy and a longer recovery period.
It is also important to mention that good surgery is not only about addressing pain. Even though your fertility plans have changed, proper excision surgery can still improve fertility outcomes, as demonstrated in many publications from endometriosis excision experts. This improvement is seen across all stages of the disease and is especially significant in patients under 35 years of age. It benefits both natural conception and IVF results, should you decide to pursue IVF again.
In conclusion, I would strongly recommend starting with proper imaging-based endometriosis mapping and then deciding on excision surgery. Both steps should be done by an endometriosis excision expert.
Take care.
Best wishes,
Dr. Jurgis Vitols
As an endometriosis specialist, your concern is completely valid. The technique of ablation is no longer considered appropriate for treating endometriosis, as it often leaves residual disease and does not improve fertility outcomes; the current standard of care is complete excision of all lesions. Since your pain did not improve and your fertility treatments were unsuccessful, it is reasonable and not an overreaction to have your case re-evaluated by an excision specialist, even if your day-to-day symptoms feel manageable. Endometriosis can progress silently and impact fertility and pelvic anatomy, so reassessing your situation now may help you make a more informed decision. This evaluation can indeed be valuable from a reproductive standpoint