What would you recommend my next steps be? How aggressive should I be in getting pregnant right away since I only had a two years between surgeries was regrowth or large endometriomas? Thank you.
Unfortunately, Stage 3 and 4 endometriosis have been found to significantly decrease fertility rates. This is because endometriosis cause a chronic inflammation of the pelvis that recruits inflammatory cells and these cells attack and destroy the eggs when ovulation occurs (this of course is putting is very simply for ease of understanding). In stage 4 endometriosis, severe adhesions or scar tissue formation occurs in the pelvis. These adhesions are like spider webs so that when the egg exits the ovary and moves into the pelvis, prior to finding the tube, the eggs get caught in these spiker webs or the webs block the tubes so that the egg never gets into the tube where fertilization takes place.
In terms of the recurrence of endometriosis or endometriomas, this is a chronic disease and new implants are continuously forming. For that reason, you can form new endometriomas, despite the previous ones being removed.
Dr. Edward J. Ramirez, M.D., FACOG Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Executive Medical Director
Monterey, California, U.S.A.