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Should I freeze my eggs if I have endometriosis and I am not currently trying for pregnancy?

Endometriosis is a relatively common medical condition in women of reproductive age. Although it usually causes menstrual pain, for many it is a silent disease which, among others, can affect fertility too. 

When faced with the diagnosis of endometriosis, your doctor will typically discuss with you the various options available to treat symptoms, including medicines or surgery. However, as fertility may be affected in such cases of women with endometriosis, it is important to see whether there is a place for fertility preservation, in particular, egg freezing.

We know that women with endometriosis, especially with the more advanced forms of the disease, including cysts in the ovaries (endometriomas), have a lower reserve of eggs in their ovaries as they age, compared to women without endometriosis. When a blood test is taken to check on AMH levels (the hormone which reflects the ovarian reserve of eggs), results are often lower compared with women without endometriosis. Having a lower egg reserve, however, will increase the risk of your ovaries becoming inactive earlier than expected, a condition known as premature ovarian insufficiency. We also know, from previous studies, that having surgery for endometriosis, may result in lower number of eggs in the future, and this is important as the number of eggs in the ovaries affects fertility in various ways. In particular, the lower number of eggs available during IVF treatment, the lower the chance of getting pregnant.

Following these observations, scientific societies, such as the European Society of Human Reproduction and Embryology, have published guidelines on the role of fertility preservation in women of reproductive age, including the condition of endometriosis. So far, it is still under investigation, whether fertility preservation is useful and beneficial for all women with endometriosis who are not actively attempting for pregnancy. The reason being that not all women with endometriosis share the same symptoms and form of disease, as well as individuals vary a lot with regards to common factors, such as age, other fertility conditions which all can affect future fertility in different ways. Recently, investigators from Spain have examined the effects of freezing eggs of women with endometriosis when these women returned some time later to have IVF treatment with their frozen eggs (1). They found that not only the majority of frozen eggs in women with endometriosis had a high chance of surviving after thawing, but also the chance of getting pregnant through IVF was very satisfactory. 

However, although the science and technology exist on fertility preservation in women with endometriosis, both through egg freezing and ovarian tissue freezing, it is still unclear how effective these strategies are. In particular, current research is focusing on ways to identify which women with endometriosis are most likely to benefit from fertility preservation, with more likely candidates being women with more advanced forms of endometriosis, with other infertility conditions present, such as tubal problems, as well as women who are not actively try for a pregnancy, but facing a diagnosis of endometriosis and its negative impact on their ovarian egg reserves.

If diagnosed with endometriosis, it is important that you discuss with your doctor the option of fertility preservation, mainly in the form of egg freezing, taking into account the potential benefits, as well as the limitations of such strategies, including cost and medical intervention.

References:

  1. Cobo A, Giles J, Paolelli S, Pellicer A, Remohí J, García-Velasco JA. Oocyte vitrification for fertility preservation in women with endometriosis: an observational study. Fertil Steril 2020;113: 836-844.

©2021, Nicholas Christoforidis, Fertility Matters
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