What endometriosis is
Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus. It is often found on the ovaries, the tubes and the pelvic lining. This tissue reacts to monthly hormones and can cause inflammation and scarring.
Common symptoms include painful periods, pain during sex and long-term pelvic pain. Some women have no pain at all and learn about it only during fertility tests.
How it can affect fertility
Endometriosis can reduce fertility in several ways. Not every woman is affected in the same way.
- Tubes. Scarring can block the tubes or stop them from picking up the egg.
- Ovaries. Cysts called endometriomas, sometimes known as chocolate cysts, can form on the ovaries.
- Egg reserve. Endometriomas, and surgery to remove them, can lower AMH and the number of eggs.
- Pelvic environment. Inflammation may affect how eggs and sperm meet.
How endometriosis is found
An ultrasound can often show endometriomas on the ovaries. Smaller deposits on the pelvic lining usually do not show on ultrasound. A laparoscopy, a keyhole surgery, is the way to see them directly.
Not every woman needs a laparoscopy before IVF. Your doctor decides based on your symptoms, scan findings and plan.
When IVF is advised
For mild endometriosis with open tubes and good egg reserve, some couples try simpler treatment first. Our guide to IUI vs IVF explains that choice.
IVF is usually the stronger option in these situations:
- Moderate or severe endometriosis.
- Damaged or blocked tubes.
- Falling egg reserve or age in the mid-thirties or above.
- Previous surgery for endometriomas that lowered AMH.
- Failed IUI or several years of trying.
IVF bypasses the tubes and lets the lab bring eggs and sperm together directly. See our IVF treatment page for the general process.
Surgery or IVF first
This is one of the most common questions. There is no single answer for every woman.
Surgery can relieve pain and remove large cysts. But removing endometriomas can also remove healthy ovarian tissue, which can lower egg reserve. For a woman whose main goal is pregnancy and whose AMH is already low, the doctor may advise IVF first.
Surgery may be preferred when pain is severe, a cyst is very large, or a cyst makes egg collection difficult. Consult your doctor, who will weigh pain relief against protecting egg reserve.
How the IVF plan is adjusted
- Checking egg reserveAMH and an antral follicle count guide the choice of medicine dose.
- Calming the endometriosisSome women are given hormone treatment for a short time before stimulation. Your doctor decides if this is useful for you.
- Stimulation and egg collectionThe ovaries are stimulated and eggs collected as in standard IVF. Cysts are noted and avoided where possible.
- Fertilisation and embryo cultureICSI may be used if needed. Embryos are watched as they grow.
- Freeze-all and frozen transferIn some cases all embryos are frozen and transferred in a later cycle, once the body has settled.
A frozen embryo transfer costs ₹40,000 – ₹80,000. The full IVF cycle cost is ₹1,60,000 – ₹3,56,000, with an itemised list on our IVF cost page.
Endometriosis and adenomyosis
Adenomyosis is a related condition where similar tissue grows into the muscle wall of the uterus. It can cause heavy, painful periods and an enlarged uterus. Some women have both conditions.
Adenomyosis may affect how the uterus receives an embryo. An ultrasound or MRI can suggest it. If present, your doctor may adjust the timing of transfer or the medicines used to prepare the lining.
Questions to ask your doctor
- How severe does my endometriosis look on the scan?
- Is my egg reserve affected, and by how much?
- Do my cysts need removing before IVF, or can they stay?
- Would a freeze-all approach suit me?
- How will my pain be managed during treatment?
Bring any old surgery notes and scan reports. If you had a laparoscopy, the operation note shows how much endometriosis was found and what was removed. This helps the doctor plan stimulation.
Tests such as AMH and an ultrasound can often be done in your own city and shared on WhatsApp. The doctor can then plan your Delhi visits in advance.
Protecting fertility if you are not ready yet
Some women with endometriosis are not planning pregnancy now. If egg reserve is falling, freezing eggs may be worth discussing. This is especially relevant before ovarian surgery.
One egg freezing cycle costs ₹1,50,000 – ₹2,50,000. Your doctor can tell you whether it suits your situation.
Living with endometriosis during treatment
Pain may change during IVF because of hormone shifts. Tell your doctor about any new or severe pain. Do not take strong painkillers without checking, as some may not suit treatment.
Success with IVF depends mainly on age, egg reserve, sperm quality and embryo quality. Endometriosis is one more factor your doctor weighs when explaining your realistic chances.