For women being able to conceive is the greatest happiness. But, we see many conditions that are affecting the fertility of a women. One such is: Endometriosis. A condition where a tissue that is similar to the inner lining of the uterus grows outside the uterus. It often affects the ovaries, fallopian tubes and the tissue lining the pelvis. But, the challenging part is the condition can return, often bringing back pain, uncertainty, and concerns about future fertility. While surgery can offer relief, repeated procedures, especially involving the ovaries can gradually reduce ovarian reserve. Therefore, here is why fertility preservation becomes an important conversation, helping women protect their chances of having a child in the future.
A situation faced by a 30-year-old woman who had been trying to conceive for nearly three years. But, along with infertility, she had been experiencing persistent pelvic pain and severe menstrual cramps. Three years earlier, she had undergone laparoscopic surgery to remove cysts from both ovaries caused by endometriosis. At the time, the surgery provided relief from her symptoms. However, over the past year, the pain had slowly returned, and so had the concern that the disease might have recurred.
She again sought medical consultation at Milann – Fertility and Birthing Hospital, Chandigarh, under the supervision of Dr Jasneet Kaur, Senior Consultant & Clinical Director – Reproductive Medicine. A detailed evaluation was performed, where a transvaginal ultrasound confirmed the recurrence of endometriotic cysts in both ovaries. The cyst in the right ovary measured about 4.5 cm, while the left ovary had a cyst of approximately 3.8 cm, both showing classic features of ovarian endometriomas. Her further tests to assess her ovarian reserve showed Anti-Müllerian Hormone (AMH) levels of 1.1 ng/ml and an antral follicle count of six. All these results suggested a reduced ovarian reserve. Her partner’s semen analysis, however, was normal.
Dr Jasneet quoted, “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.”
The patient was explained about the risks and benefits of embryo cryopreservation. The procedure was initiated under controlled ovarian stimulation, following which eggs were retrieved and fertilized. Eventually, four healthy day-5 embryos were successfully vitrified and stored for future use.
With her embryos safely preserved, she then went ahead with the planned surgical management for the recurrent endometriomas. The approach allowed the medical team to focus on treating the disease while ensuring that her chances of having a child in the future remained protected.
In India, Endometriosis affects an estimated 40 million women in India but remains one of the least understood and underdiagnosed gynecological conditions in the country. The disease itself causes inflammation in the pelvic region and can damage the ovarian environment. Over time, it may also interfere with follicle development and egg quality. Ovarian endometriomas, in particular, can reduce ovarian reserve not only through the disease process but also during surgical removal, when healthy ovarian tissue may sometimes be inadvertently removed along with the cyst wall.
The risk becomes even more significant in women with recurrent or bilateral disease. Each additional surgery on the ovaries may further reduce ovarian reserve, which is why fertility preservation is increasingly recommended in selected patients.
Today, techniques such as egg or embryo freezing offer women the opportunity to preserve their reproductive potential before undergoing treatments that may affect fertility. However, these options are still not discussed as often as they should be in patients with endometriosis.
This case highlights the importance of awareness, early counselling and individualized treatment planning. For women with recurrent ovarian endometriosis requiring repeated surgeries, fertility preservation can make a crucial difference. Women need to prioritise their health, and changes in body could be a sign. Therefore, talking to a gynaecologist becomes important because early treatment makes huge differences.