Endometriosis and Fertility: Why Preserving Reproductive Options Matters for Indian Women

For many women, the ability to conceive represents a profound personal aspiration. Yet numerous medical conditions threaten this possibility, with endometriosis emerging as a particularly challenging concern. This condition develops when tissue resembling the uterine lining establishes itself beyond the uterus—typically affecting the ovaries, fallopian tubes, and pelvic tissue. The difficulty lies not merely in the initial diagnosis but in the disease's tendency to resurface, bringing renewed pain and worries about reproductive capacity. While surgery provides temporary respite, repeated interventions—particularly those targeting the ovaries—can progressively diminish ovarian reserve, making fertility preservation an increasingly vital discussion for affected women.

A Case of Recurring Disease

A 30-year-old woman's experience illustrates this dilemma. For nearly three years, she had pursued pregnancy without success while enduring persistent pelvic discomfort and severe menstrual pain. Three years prior, she had undergone laparoscopic surgery to remove endometriosis-related cysts from both ovaries. The procedure initially relieved her symptoms. However, over the past year, pain gradually resurfaced alongside suspicion that the condition had returned.

At Milann – Fertility and Birthing Hospital in Chandigarh, Dr Jasneet Kaur, Senior Consultant and Clinical Director of Reproductive Medicine, conducted a comprehensive assessment. Transvaginal ultrasound imaging revealed recurrent endometriotic cysts in both ovaries: the right ovary contained a 4.5 cm cyst, while the left measured approximately 3.8 cm, both displaying characteristic endometrioma features. Testing of her ovarian reserve indicated an Anti-Müllerian Hormone level of 1.1 ng/ml and an antral follicle count of six—both markers of diminished reserve. Her partner's semen analysis, by contrast, showed normal results.

The Dilemma: Surgery Versus Fertility

The medical team faced a significant challenge. Though repeat surgery had been recommended due to symptom severity and cyst size, the patient's history demanded careful consideration. Having already undergone ovarian surgery once, with disease now present bilaterally, another intervention risked further compromising her ovarian reserve and reducing future conception prospects.

"Because of her symptoms and the size of the cysts, repeat surgery had been suggested earlier. However, considering her medical history, the doctors carefully evaluated the situation before proceeding. She had already undergone ovarian surgery once, and the disease had now returned in both ovaries. Another surgery carried the risk of further reducing her ovarian reserve, which could make conceiving later even more difficult. This is where fertility preservation becomes important. The patient was counselled about the possibility of preserving embryos before undergoing surgery again. This approach would allow and guarantee her to safeguard her reproductive potential," Dr Kaur explained.

The patient received detailed counselling regarding embryo cryopreservation benefits and risks. Following controlled ovarian stimulation, eggs were retrieved and fertilized, resulting in four healthy day-5 embryos that were successfully vitrified and stored.

With her embryos secured, the patient proceeded with surgical management of the recurrent endometriomas. This strategy permitted disease treatment while simultaneously protecting her future reproductive prospects.

Endometriosis: A Widespread Yet Underrecognized Condition

Approximately 40 million women in India experience endometriosis, yet it remains among the country's least understood and underdiagnosed gynecological disorders. The condition triggers pelvic inflammation and can harm the ovarian environment. Progressively, it may impede follicle maturation and compromise egg quality. Ovarian endometriomas particularly threaten ovarian reserve—both through disease progression and surgical removal, when healthy ovarian tissue may be inadvertently excised alongside the cyst.

The threat intensifies substantially for women with recurrent or bilateral disease. Each additional ovarian surgery potentially further erodes ovarian reserve, establishing a compelling rationale for recommending fertility preservation in appropriately selected patients.

Emerging Solutions and the Path Forward

Modern techniques including egg and embryo freezing now enable women to preserve reproductive capacity before undergoing treatments that could impair fertility. Regrettably, these options remain insufficiently discussed among endometriosis patients.

This case underscores the necessity of heightened awareness, timely counselling, and treatment approaches tailored to individual circumstances. For women with recurrent ovarian endometriosis requiring multiple surgeries, fertility preservation can prove transformative. Women should heed bodily changes and consult gynecologists promptly, as early intervention substantially improves outcomes.