Millions of women worldwide suffer from endometriosis – a painful and frequently misunderstood condition. It happens when uterine lining-like tissue (endometrial tissue) grows outside the uterus, causing inflammation, scarring, and infertility in many cases. Whether surgery can totally cure endometriosis is one of the most frequent queries posed by women suffering with endometriosis. Dr Vandana Bhatia, Fertility Specialty at Nova IVF Fertility, Vasant Vihar in New Delhi says that despite the fact that surgery can help control symptoms and increase fertility, endometriosis is a chronic condition that necessitates ongoing care rather than a one-time surgical solution.
Recognising Endometriosis and How It Affects Fertility
According to Dr Bhatia, endometriosis is a common cause of infertility and can affect the fallopian tubes, ovaries and other organs in the pelvis. Some of the common symptoms of endometriosis are:
- Painful periods
- Heavy bleeding during periods
- Chronic pelvic pain
- Dysuria
- Diarrhea
- Infertility
"It can cause chronic inflammatory reaction leading to blocked fallopian tubes, scarring, adhesion formation, ovarian cysts (endometriomas) all distorting the pelvic anatomy. Further it can also interfere with ovulation, impair the quality of eggs, disturb the receptivity of the endometrium, alter the immune system thus making the environment unfavorable for implantation. All these factors make conception challenging," explains Dr Bhatia.
Despite these challenges, many women with endometriosis can conceive naturally while few may have to resort to assisted treatments like Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF).
Can surgery cure endometriosis?
Dr Bhatia says for women with moderate to severe endometriosis, surgery may be recommended, especially if symptoms become impairing or if fertility is impacted. She says the two most common surgical procedures are laparoscopy and laparotomy. For the diagnosis and excision of endometriotic lesions, adhesions, and cyst removal – laparoscopy – a minimally invasive procedure – is the gold standard. "It allows surgeons to remove or destroy endometrial tissue while preserving the reproductive organs."
Laparotomy, on the other hand, is a more invasive open surgery, which is "rarely performed". Even though surgery can greatly reduce discomfort and enhance the chances of conceiving, Dr Bhatia says it is not a permanent solution. "Endometriosis has a high recurrence rate and research indicates that lesions and symptoms may resurface a few years even after surgery, especially in women who do not get post-operative hormone therapy," warns Dr Bhatia.
Role of surgery in fertility treatment
Explaining the importance of surgery for endometriosis, Dr Bhatia says, it can improve fertility in women with endometriosis-related infertility by normalising pelvic distortion, reducing scar tissue and inflammation and even enhancing the quality of eggs and endometrial receptivity. "An effective laparoscopic approach may improve the outcome of reproductive treatments for women with adhesions or ovarian endometriomas but when considering surgical treatment for such patients, it should be kept in mind that ovarian reserve can be reduced both due to the disease process itself and also by the surgery involving endometrioma removal," explains the fertility specialist.
Therefore, it is important for fertility specialists as well as for the patient to discuss all options of surgery together with the pros and cons of each option before attempting surgery. "A proper plan of treatment needs to be formulated on an individual basis depending on the patient’s history, symptoms, extent of endometriosis, ovarian reserve and other factors," suggests Dr Bhatia.
Additionally, IVF and other assisted reproductive technologies might be a better option than surgery in many circumstances or "the infertility treatment can be a combined approach involving both IVF and surgery."
Long-Term Endometriosis Management
Unfortunately, endometriosis cannot be completely cured, hence while managing this condition, Dr Bhatia says that the focus should be on improving the quality of life, alleviating pain, reducing endometriotic lesions, and treating infertility. "Long-term treatment plans should be tailored according to individual needs. This may need a combination of hormonal therapy, pain management and lifestyle modifications," she explains.
Women who do not wish to conceive in near future may be administered birth control pills or hormone therapy, "such as GnRH agonists, to slow the progression of the disease." A few steps that can help manage endometriosis are:
- Anti-inflammatory diet
- Stress management
- Counselling and Maintaining a Healthy Lifestyle
- Continuous monitoring and regular follow ups
- Long-term medical therapy to treat symptoms and prevent recurrence
"Even though surgery can improve fertility and lessen discomfort, it is not a permanent cure. To manage and treat endometriosis, one should always consult a fertility specialist to develop a personalised treatment plan for improving reproductive outcomes," suggests Dr Bhatia.
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