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Endometriosis And Infertility: Minimally Invasive Endometriosis Excision Protects Fertility

Endometriosis and fertility

Endometriosis-related infertility can be treated with surgical intervention


Endometriosis is a painful chronic condition that occurs when cells, similar to those in the lining of the uterus, are discovered in the pelvic cavity. In rare cases, endometriosis has been found in other areas of the body, including the lungs and in the brain. These cells behave like the cells found in the uterine lining, and each month the surrounding tissue can become irritated. Inflammation from endometriosis may lead to scar tissue or pelvic adhesions which can result in severe pain with every monthly cycle. If ignored, the pain can become constant.

Endometriosis can develop at any time during a woman’s life, and sometimes as early as a woman’s first menstrual cycle. Symptoms are often debilitating and may include painful periods, pain with sex, pain with using the bathroom, heavy bleeding, and infertility. While women suffering from endometriosis may not look sick, they can sometimes be in so much discomfort that they aren’t even able to leave their beds — affecting school, work, and personal relationships.


Sadly, more than five million women in the U.S. suffer with endometriosis and, while difficult to diagnose, this disorder not only causes extreme pain, it can often also lead to infertility. At The Center for Innovative GYN Care® (CIGC®), our laparoscopic GYN specialists are fellowship-trained and have the expertise to diagnose and remove this complex GYN condition with a minimally invasive endometriosis excision technique, which may help women get pregnant. While there are treatment options for endometriosis, currently, there is no cure for the disease.

After trying to get pregnant for four years, Brittany — a CIGC patient — suspected a pre-existing dermoid ovarian cyst was the cause of her fertility issues, and she sought out a specialist.

“I had surgery with Dr. MacKoul to remove the dermoid cyst, and it was discovered during that surgery that I had endometriosis and bowel adhesions,” Brittany said. “They cleaned me all up. Following my initial surgery, we returned to my doctor who suggested IVF. My husband and I wanted to try on our own first. If it didn’t happen, we would go back to Shady Grove, but I got pregnant within a month.”

The way endometriosis affects fertility is not clear, but approximately one-third to one-half of women with endometriosis have difficulty getting pregnant. A common belief is that the condition can impact the quality of eggs being produced. Another theory is that the inflammation associated with endometriosis has the potential to create a toxic environment for a fetus or even fuse organs together (an advanced stage of endometriosis known as frozen pelvis), including the uterus, fallopian tubes, ovaries, bladder, and bowels.

Another way endometriosis can impact pregnancy is by presenting itself as a cyst that can form on the ovary, which could affect the development of eggs to be fertilized. These same cysts can also grow on fallopian tubes which can result in an ectopic pregnancy. When faced with fertility issues, intrauterine insemination (IUI) or in vitro fertilization (IVF) are often top of mind. While those fertility treatments can work on their own, any underlying issue — such as endometriosis — must be treated first for the treatment to be successful. Removal of endometriomas can dramatically increase the success rates of natural pregnancy and is crucial for those patients who need IUI or IVF treatments.

The earlier the GYN condition is treated, the better chance for conceiving and carrying a child to term, especially when performed by a specialist. Removing endometriosis through excision using a minimally invasive approach — such as DualPortGYN® — can clear the path for a successful pregnancy. At CIGC, we often treat patients who go on to conceive immediately after surgery.

Bela, a CIGC patient, tried fifteen fertility treatments over the course of a decade without a successful pregnancy. Endometriosis removal was her last attempt before seeking donor eggs.

“We decided to do another laparoscopy to take a fresh look at my uterus and tubes. Before doing my last IVF cycle with my own eggs, I wanted to cover all bases,” said Bela. “Dr. MacKoul discovered stage 1 endometriosis during the laparoscopy. It was around the ureters.”

After Dr. MacKoul removed the endometriosis, Bela had two eggs implanted and had her first successful pregnancy.

“I was completely hopeless. Infertility had swallowed me. I had several failed IVFs, too many infertility issues, and several losses. I could never imagine having a baby in my arms. And now I have two of them!”


Complete removal of endometriosis by a surgical expert is critical for potential pregnancy success and pain management. Depending on the extent of the disease, the surgeon may be able to take a conservative approach to removal to preserve the ovaries, fallopian tubes, and uterus for fertility, or the surgeon may need to remove the ovaries to control the production of estrogen. While endometriosis cannot fully be cured, choosing a GYN specialist for removal is an essential part of managing the condition. If removed incorrectly, endometrial implants can continue to cause pain and affect fertility.

At CIGC, our specialists, Dr. MacKoul and Dr. Danilyants, developed DualPortGYN, a minimally invasive technique used for minimally invasive endometriosis excision. This procedure uses two 5mm incisions, one at the belly button and another at the bikini line, so patients have a better overall recovery and return home the same day. All procedures are performed in an outpatient setting. The DualPortGYN technique uses an advanced procedure that maps the pelvis, allowing for complete identification of all the structures of the pelvis — such as the bowel, bladder, ureters, and large vessels — allowing for safe, fertility-friendly, and effective results with the best recovery possible.


The CIGC state-of-the-art specialists are available at three locations in the DC metro area. Virginia patients can visit the Reston, VA location, and Saturday appointments are available. Maryland offices are located in Rockville, MD.

CIGC is dedicated to providing information and materials for women to help navigate the complicated healthcare system. The CIGC founders, minimally invasive GYN surgical specialists Dr. Paul MacKoul, MD and Dr. Natalya Danilyants, MD, developed their advanced GYN surgical techniques using only two small incisions with patients’ well-being in mind.

Their personalized approach to care helps patients understand their condition and the recommended treatment so that they can have confidence from the very start. Our surgeons have performed over 20,000 GYN procedures and are constantly finding better ways to improve outcomes for patients.

Book a consultation today with Paul MacKoul MD or Natalya Danilyants MD.

Dr. Paul MacKoul Reviews: Vitals | RateMDs | Google | Wellness | UCompare

Dr. Natalya Danilyants Reviews: Vitals | RateMDs | Google | Wellness | UCompare