Endometriosis and PCOS: excision surgery and mild IVF

Deep infiltrating endometriosis and polycystic ovary syndrome (PCOS) are very different conditions sharing one dilemma: treating symptoms without compromising future fertility. In both, the order of decisions matters as much as the technique.

In deep endometriosis, meticulous laparoscopic excision by multidisciplinary teams (gynaecology, colorectal surgery and urology) relieves chronic pelvic pain long term in more than 80% of cases. The key is preserving ovarian reserve, measured by AMH, avoiding excessive coagulation of healthy ovarian tissue. Surgery carries a risk of urinary or bowel injury, so team volume is decisive.

In PCOS the problem differs: there is a high risk of ovarian hyperstimulation syndrome during IVF, requiring mild stimulation protocols, agonist trigger for final maturation, freeze-all embryo strategies and, in selected cases, in vitro maturation. Metabolic management of weight and insulin resistance is part of treatment, not an add-on.

Spain and the United Arab Emirates host centres of excellence where gynaecological surgeons and embryologists work in an integrated way to maximise reproductive potential. The range is EUR 4,000 to 9,000, with seven to fourteen day stays depending on whether surgery and an IVF cycle are combined.

At medviajes we compare accredited units experienced in deep endometriosis and coordinate travel, pre-tests and follow-up. The plan must be set by a qualified reproductive gynaecologist.