QC: Excision Surgery Before Fertility Treatments: The Expert Approach

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Two leading endometriosis specialists discuss why performing excision surgery before fertility treatments often leads to better outcomes for patients struggling with both endometriosis and infertility.

• Dr. Sadikah Behbehani recommends excision surgery before IVF when endometriosis is suspected
• Removing endometriosis first may enable natural conception without needing IVF
• When IVF is still needed after surgery, success rates are significantly higher
• For patients with both PCOS and endometriosis, ovarian drilling can be performed during the same surgery
• Ovarian drilling creates small holes in the ovary to reduce androgen production and help with ovulation
• While not done as a standalone procedure anymore, ovarian drilling has minimal side effects when performed during endometriosis surgery

Have questions about endometriosis or fertility? Send them in using the link in the episode description, email [e-mail], or visit the endobattery.com contact page.

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Episode Transcript

Speaker 1 (00:00):
Life moves fast and so should the answers to your
biggest questions.
Welcome to EndoBattery's QuickConnect, your direct line to
expert insights Short, powerfuland right to the point.
You send in the questions, Ibring in the experts and in just
five minutes you get theknowledge you need.
No long episodes, no extra timeneeded, and just remember

(00:20):
expert opinions shared here arefor general information and not
for personalized medical advice.
Always consult your providerfor your case-specific guidance.
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect Today.

(00:53):
I'm excited to welcome two ofthe most accomplished experts in
endometriosis care to the table.
First we have Dr SadiqaBebehani, a double fellowship
trained OBGYN, specializing inreproductive endocrinology and
infertility, as well asminimally invasive gynecological
surgery.
Dr Bebehani completed a secondfellowship at the prestigious
Mayo Clinic, where she masteredcomplex pelvic surgery using
both laparoscopy and robotics.

(01:14):
As an associate professor atthe University of California
Riverside School of Medicine,she is also deeply involved in
medical research andpublications.
With her rare combination oftraining in surgery and
infertility, dr Babiani isuniquely equipped to treat
complex gynecologic conditionssuch as endometriosis and
fibroids that affect fertility.

(01:34):
We're also joined by Dr LauraLiu, a highly respected
board-certified excision surgeonspecializing in deep excision
of endometriosis.
Dr Liu is known for herexpertise in minimally invasive
techniques and her dedication toproviding patients with
evidence-based care that bringslong-lasting relief.
With her background in bothgynecology and robotic surgery,

(01:54):
she has helped countlessindividuals find a path to
healing after enduring years ofchronic pain.
Together, both Dr Bebehani andDr Loralu bring an incredible
wealth of knowledge to today'sdiscussion.
Let's dive in.
Do you notice a significantdifference for those who have
the surgery for endometriosisfirst, as opposed to having it

(02:15):
after trying, like IVF or othermethods to becoming pregnant?

Speaker 2 (02:19):
Absolutely.
I wouldn't even proceed withIVF if we had a strong suspicion
for endo, because the surgerymay save them the cost of IVF.
If we do the surgery and wefind endo and we treat it, then
they may have a good chance ofgetting pregnant naturally
without IVF.
And if they don't get pregnantand we still do IVF, their
chances of pregnancy with IVF isgoing to be significantly

(02:42):
better than if the endo wasstill there and we hadn't
removed it.
And I'm going to add one morething to the discussion, and I'm
not sure if Dr Liu does that ornot, but when I have my PCOS
patients go in for surgery forendometriosis, I actually will
do ovarian drilling, since I'mthere, you know might as well.
Ovarian drilling is a surgicalprocedure that was done very
often in the older days whenfertility treatment was not as

(03:05):
available.
So we would go in andsurgically poke holes in the
ovary.
Those holes are meant torelease that thick layer where
the androgens are being produced.
Remember I mentioned theelevated male type androgens
that we see with PCOS patients.
So those are produced by cellscalled the theca cells.
The theca cells are around thecortex, the superficial layer of

(03:25):
the ovary.
So if we poke multiple holes inthe ovary.
That's called ovarian drillingand it actually helps women
ovulate and overcome thatproblem of elevated androgens.
We don't nowadays take women tosurgery just for that, and 20
years ago people used to do that.
But nowadays, because we haveso much more advancement in
medicine, we give them pillsrather than, you know, take them

(03:46):
to the OR.
But if I'm there doing theirendo excision surgery and I know
they have PCOS, I will addovarian drilling to my procedure
.
But Sadiqa it has to beconfirmed PCOS Correct.
So if I've diagnosed themalready based on their hormone
checks the Rotterdam criteriathey fit the diagnosis of PCOS.
They have infertility.
They're trying to get pregnant.
We also suspect endo.

(04:07):
When I go in for my surgery toremove and treat the endo, since
I'm there, it literally takes10 seconds to poke 10 holes on
each ovary.
Yeah, sure, and there are noside like, no significant side
effects.
Help, that's the data is.
You know it's maybe not asconsistent in helping get
pregnant, but there are no sideeffects or harm, since we're

(04:28):
there already doing somethingelse.

Speaker 1 (04:29):
Right, that's a wrap for this quick connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming, send them inand I'll bring you the expert
answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at endobatterycom or visitingthe endobatterycom contact page.

(04:54):
Until next time, keep feelingempowered through knowledge.
Thank you.