Superficial endometriosis is linked to infertility.  Laparoscopic management of superficial endometriosis improves fecundity rates, particularly natural conception rates, in appropriately selected patients. On the other hand, laparoscopy cannot be routinely recommended in all cases of unexplained infertility, particularly if there are no symptoms of co-existent pelvic pain, neither can it be routinely recommended routinely prior to planned in-vitro fertilisation (IVF). The final decision to undertake laparoscopy or not should be based on a multitude of factors and decided upon, following an in-depth consultation with a clinician specialised in the management of endometriosis. The development of non-invasive diagnostic methods may change the management of unexplained infertility cases in the future.

We are aware that superficial endometriosis constitutes one of the three main phenotypes of endometriosis. The diagnostic dilemma persists, as superficial endometriosis is not visible on ultrasound or MRI of the pelvis. Therefore, laparoscopy is the only method to accurately diagnose it, giving us the opportunity to excise superficial endometriosis at the same time. The appearance of superficial endometriosis may, however, vary greatly between cases.

The mechanisms through which superficial endometriosis causes infertility are various, including reduced coital frequency due to painful sexual intercourses, chronic inflammation and resulting oxidative stress that may negatively affect oocyte quality and ovarian reserve, as well as a possible toxic effect on sperm and implantation of the fertilised ovum. Let us not forget that, in a percentage of cases, adenomyosis of the uterus may co-exist, bearing a negative impact on fertility outcomes.

The rationale behind excision of superficial endometriosis lesions is that, by completely eradicating those lesions, we are able to reverse the inflammatory environment that negatively impacts on the woman’s fertility. Furthermore, due to chronic inflammation, there may be co-existent adhesions involving the fallopian tubes and/or ovaries, that may also be corrected during the same laparoscopic surgery. We can also, concurrently, perform a fallopian tubal patency test, as well as a hysteroscopy, to assess the shape and anatomy of the uterine cavity. Laparoscopic surgery gives us the opportunity to perform all those with minimal blood loss and pain. Compared to open surgery, it offers improved vision of endometriosis lesions, a shorter recovery period and an improved aesthetic result.

If you suffer (or suspect you may suffer) from endometriosis, do not hesitate to contact us for a consultation!