How to manage with infertility struggles

Medically reviewed by Dr. Karen Amaniampong

If you are trying to conceive and have endometriosis, Dr. Karen Amaniampong has listed the following strategies you can take.  

You will usually take a fertility test, which can be performed by a gynaecologist or fertility specialist. Your GP can also refer you to take the following tests: 

• General health tests to measure your Body Mass Index (BMI), blood pressure, and any existing medical conditions related to infertility. 
• Blood tests to check hormone levels and ovarian reserve, which provides information about the number and quality of eggs released by your ovaries. 
• Ultrasounds to check for any structural changes in your uterus, fallopian tubes, or ovaries that may be preventing fertilisation. 
• Tubal patency tests to perform hystersosalpinography, hysteroscopy orlaparoscopy 

In general, if you are unable to become pregnant after more than one year of trying, Dr. Amaniampong recommends considering fertility testing. If you are over 35 years of age, you should consider testing after 6 months of trying to become pregnant.  

If you have endometriosis and are trying to become pregnant, Dr. Amaniampong does not recommend continuous hormonal treatment. This is because hormonal treatments suppress the symptoms by reducing oestrogen levels, therefore preventing ovulation (the release of an egg cell).  can be beneficial for all stages of endometriosis, followed by assisted reproduction in severe cases (Stage III/IV). 

• Mild to moderate endometriosis (Stage I/II): Ablation or excision of endometriosis lesions through laparoscopy is recommended, in addition to adhesiolysis to remove any scar tissue. If the patient is 35 years or younger, Intrauterine Insemination (IUI) can be performed providedthat male factor infertility is negligible. 

• Severe endometriosis (Stage III/IV): The appropriate treatment is In-Vitro Fertilisation (IVF) and Embryo Transfer (ET). Studies have shown more success in pregnancy rates when the individual undergoes an integrated IVF-ET laparoscopy approach compared to just laparoscopy alone. In severe cases, prolonged hormone addback treatment is recommended to manage the side effects of using hormones required through IVF. Cases of deep endometriosis require extensive multidisciplinary clinical expertise. 

• Endometriosis with ovarian cysts: Cystectomy, which is a laparoscopic procedure to remove ovarian cysts, is performed prior to IVF if the cysts are larger than 3 cm. The ESHRE (European Society of Human Reproduction and Embryology) recommends that clinicians should counsel their patients on the risks this surgery may pose to ovarian reserve, especially if the patient has had previous ovarian surgery. In some cases, the presence of large cysts do not impact the number or quality of healthy follicles, so surgery is not always recommended.  

If you are worried you may be suffering from infertility related to endometriosis, we highly recommend that you contact your GP, gynaecologist, or fertility clinic for help to discuss your fertility options. Joining a support group can also be beneficial to help manage your mental well-being and the emotional challenges that accompany infertility.  

These are secular, non-denominational charities that do not discriminate based on gender, age, nationality, background, or faith. They aim to provide education, resources, and in-person or online support for people experiencing infertility to help them navigate their options and make informed decisions.  

Fertility Network (UK and Ireland based): https://fertilitynetworkuk.org/  

NISIG (Ireland based): https://nisig.com/  

Resolve (US based): https://resolve.org/