Will IVF work if you have endometriosis? Columnist Emma Kemsley investigates how endometriosis impacts the success of IVF. Can you get pregnant with IVF if you have endometriosis?
Does IVF cause more endometriosis pain?
Those were the questions I frantically Googled as I embarked on my first IVF cycle in 2018.
The search revealed contradictory articles. Studies with non-conclusive results.
First-person accounts of both pregnancy success and loss. I was more confused than when I started.
Fast forward three years, and I still don’t have the answer to the questions, however, I have learnt a lot. Endometriosis affects 1 in 10 women in the UK. It’s debilitating, painful and one of the biggest causes of infertility. I was advised I would need IVF when I woke up from my first laparoscopy. However, at age 27, I wasn’t ready for children, and I didn’t start fertility treatment until I was aged 30. Earlier this year, we embarked on our seventh IVF cycle. A short protocol with a high dose of medication secured our best cycle to date. Nine eggs were retrieved, six fertilised and we were fortunate to get four good quality blastocyst embryos. The doctor advised a freeze all cycle to let my endometriosis and adenomyosis calm before transferring an embryo. The cycle failed.
In August 2021, I had my eighth embryo transfer.
Under the microscope the day six embryo was perfect. It continued to grow and hatch upon defrosting. My endometrium lining was thick and healthy.
My endo was calm thanks to medical menopause. The doctor and embryologist were both excited this could be the one. The cycle failed. No one can give me an answer as to why. During the course of our fertility journey, I have tried both long and short protocols. I have had endometriosis surgeries. I have removed my fallopian tubes. I have tried GnRH agonist therapy – a form of medication that medically manages your menstrual cycle and simulates menopausal symptoms. However, my IVF has continued to be unsuccessful. I am running out of options – and money.
Though I can only share the difficulties of endometriosis and IVF, it’s not the same for everyone. Just as endometriosis causes varied symptoms and responds differently to treatments in each individual, the patterns of IVF and endometriosis follow suit. This makes it challenging for doctors to fully grasp the best method for each patient. There is no one size fits all.
There is no certainty that endometriosis will mean you need IVF. There is no set outcome of success for IVF and endometriosis either. Unfortunately, there is no magic wand – trust me, I would have found it by now. For some natural conception is still an option, others will have successful IVF, while some, like me, will not. Endometriosis and fertility come with their challenges, it’s essential to listen to medical advice and do what’s right for you.
IVF and endometriosis - Sucess stories from our readers
Jade Baker, 35, is the mother of two. She has been diagnosed with stage II endometriosis in 2012 at the age of 26. She’d regularly pass out from the pain. She was given the coil to manage symptoms. “The coil didn’t agree with me,” she said. “However, I left it because I just thought that’s what women have to go through.”
In 2014 Jade got married and began trying for a baby. With every period that passed, her pain got worse. After eight months, she was referred to a gynaecologist. A second surgery revealed her endometriosis had progressed to stage IV. It was suggested she’d need IVF but also another surgery in the future.
As a hospital pharmacist and due to the IVF postcode lottery, Jade knew it was essential to maximise her chances of success. She requested a referral to an endometriosis surgeon and underwent another surgery to treat bowel and bladder endo, a frozen pelvis and recurring endometriomas. Jade was also diagnosed with adenomyosis, a condition that also affects fertility. Post-surgery she was put on Zoladex; a GnRH agonist therapy used to manage endometriosis symptoms.
“It was really hard,” she explained. “The hot flushes were awful.” She also lost three stones in weight to qualify for IVF NHS funding.
In 2017, Jade had her first cycle of IVF, which resulted in six blastocyst embryos. The first fresh transfer resulted in a chemical pregnancy. Continuing with Zoladex as a down-regulation, three months later she transferred a frozen embryo. The IVF was successful, and she welcomed her little boy to the world in November 2018.
In summer 2020, Jade transferred another frozen embryo, following five months of Zoladex treatment. She gave birth to her baby girl in May 2021.
“I put my success down to good embryos, surgery and Zoladex,” she said. “It was important to keep the endo calm. I am so lucky it worked, but I am already suffering with endo symptoms. I need another surgery. I can’t stay on the pill forever, but I also can’t keep having surgery.”
Francesca White, 24, is the mother of two daughters under two. She was diagnosed with stage IV endometriosis including adhesions to her bowel, via laparoscopy, in August 2018. Unusually, she was offered a hysterectomy. Francesca declined and proceeded with surgery to treat her endometriosis which included a bowel resection in October 2018.
She said: “2018 was a hard year. I had two surgeries and I was mentally unwell. I was sectioned in a mental health hospital for a short stay. When I was diagnosed, I didn’t feel like I had a life worth living. I was in pain every day. I was constantly crying. I didn’t want to live like that.”
Following her surgery, and thanks to a supportive partner, Francesca’s symptoms improved. She had tried to conceive for three years, but six months after surgery, on the day of her IVF referral, she found out she was pregnant.
“I wouldn’t have fallen pregnant without the surgery,” she explained. Despite a complicated delivery, secondary infection and challenging endometriosis post-partum, Francesca fell pregnant again naturally four months later.
“We didn’t want to risk a struggle. I was scared of not getting pregnant again. The second was a lovely pregnancy and wonderful home birth. However, now I have children I feel my endo is disregarded. Lots of people are under the impression pregnancy cures it, and it doesn’t.”