Fertility Preservation in patients with Endometriosis

In the modern day, practice for endometriosis, especially when surgical management is planned, the patient must understand that a lot of girls who are undergoing the surgery are actually young and are in their early reproductive age group. As a result of this conservation of fertility becomes a very very very important aspect, in the surgical planning and management.

As an endometriosis expert performing these surgeries across the country of India, we have noticed and realized that fertility preservation is a demand and there is an extremely good awareness of the same across the nation. As a result of this, we usually like to undergo a detailed one-on-one session with the patient, to help her choose and guide her family as to what may be the best option for her to preserve her fertility.

Endometriosis is one of the leading causes of infertility and it is also associated with low AMH in many cases. As a result of this if the patient is already married and has a low AMH and is planning for future conception options for alcohol injection inside the endometriotic cyst are given to the patient. 

One must note and understand that this procedure does not give a permanent cure for endometriosis. The procedure for fertility would usually begin within 6 to 8 weeks of alcohol injection. Patients should understand and realize that though there is an option of injecting alcohol, trans vaginaly, laparoscopic method remains the procedure of choice as it allows for freeing up a lot of adhesions, thereby improving the quality of the oocytes.

Simply performing drainage of endometriotic cyst and not clearing the rest of the disease is often done by experienced surgeons who for the fear of losing the patient, do not end up referring to the specialists. 

Whenever there is an indication meticulous surgery should be performed in order to clear up all the patches of deep endometriosis and simultaneously the surgery should encompass a meticulous dissection in order to prevent the maximum amount of ovarian tissue.

Usually, this is going to be achieved only by doctors who specialize in surgery for endometriosis, because this involves a lot of fine points of dissection as well as understanding of the anatomy. 

After the surgery is finished, it is confirmed that the surgery is complete. The patient is then referred either for cryopreservation of oocytes or for embryos if the patient is already married. 

During the time of the surgery, at advanced units like ours, we also give the option to the patient for undergoing ovarian tissue banking. This is a system of slow freezing and it’s an expensive procedure at the moment in India. 

As a result of this, many girls opt to do Egg Banking instead which is a simple and safe procedure and can be done to bank up to 12-16 oocytes. These oocytes which are banked can be used later as a backup once the marriage and family are planned by these girls. 

Egg banking is a relatively inexpensive procedure as compared to ovarian tissue banking. Both the procedures are performed by our team as a referral unit for both fertility as well as endometriosis, this is an advantage to the patient to carry out both procedures in the same setting.