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The following information was shared by the Department of Obstetrics & Gynaecology​ at S​ingapore General Hospital (SGH), a member of the SingHealth group.

Surgical treatment for endometriosis

Surgical treatment requires the help of a gynaecologist who specialises in minimally invasive or keyhole surgery. For minimal to moderate disease (Stage 1-3), the surgeon should be comfortable to diagnose the problem during laparoscopy and surgically remove it, preferably by excision, at the same time to get the best chance of pain relief.

If your gynaecologist discovers severe disease then, to treat it at the same time, they should have discussed with you the pros and cons of surgical removal. In severe cases, endometriosis surgery is a high-risk complex operation that should only be attempted by a fully trained expert.

Not everyone requires surgical removal of severe disease as it can compromise your fertility. Robotic keyhole surgery now potentially offers the most accurate and precise surgery for severe cases of endometriosis.

Your gynaecologist should also be able to offer you access to other specialists as required, for example:

  • Chronic pain clinics
  • Bowel specialists
  • Bladder specialists and
  • Psychological and psycho-sexual support

Related article:  Keyhole Surgery Used to Treat Uterine Fibroids

Endometriosis-associated infertility

If you are found to have endometriosis-associated infertility then the choice is whether to have surgery or assisted fertility treatment like in vitro fertilisation (IVF).

With minimal to moderate endometriosis, there is some evidence that removing the endometriosis deposits or endometriotic ovarian cysts improves your chances of conceiving spontaneously, hence avoiding the need for assisted conception techniques. Most of these pregnancies occur in the first six months after surgery. It also appears that the success rate for IVF treatment is lower for women with endometriosis, and that the IVF success rate significantly improves after surgical treatment of endometriosis.

For many women with severe endometriosis, it may be better to have IVF in the first instance so as not to risk affecting your fertility further from surgical complications. There are two circumstances where this may not be the case and surgery may be needed first:

  1. The pain is so severe that it is the major problem, rather than the fertility issue, and medical therapy cannot control it

  2. You have large endometriotic cysts on the ovaries that are interfering with the infertility specialist’s ability to collect eggs

Endometriosis can be a physically and mentally debilitating disease affecting every aspect of a woman’s life. Women with endometriosis tend to have more problems maintaining their careers and relationships than average as they may be fighting with chronic pain and fertility issues. Seeing a gynaecologist who specialises in this area and has access to supporting clinics in other specialties gives a good opportunity to keep the pain under control and achieve a woman’s fertility aspirations.​

Related article:  Types of Fertility Treatments and Their Risks

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