Laparoscopy before IVF?

Dear Robert,
I’ve just read your Essential Fertility Guide book, and caught the tail end of your discussion with Vanessa Feltz during one of her recent BBC Radio London shows.
I’m 34 years old, trying to conceive for 2 years. Recently diagnosed with 2 endometriomas on right and left ovaries (15x29x27mm), HSG show tubes are clear, thyroid and hormone tests done all fine, progesterone levels fine, positive ovulation tests every month. My LH, FSH is normal, AMH is low for my age at 8 pmol. Husband’s semen analysis normal.
I’ve never received formal diagnosis that I have endometriosis (other than via ultrasound). I experience no pain during sex, sometimes I have stabbing pain in my rectum and down thighs and bad pain in lower back during my period with spotting beforehand. We have recently been approved for 2 cycles of IVF on the NHS, my question to you is – would you advise Laprascopic surgery before going in for the IVF? I’ve had no clear advice from my gp, and read conflicting information online. My primary concern is 2 fold, potentially wasting these 2 free cycles due to some issue internally that wasn’t investigated and treated in advance, or having the surgery first but my AMH levels dropping as a result, therefore reducing our chances of success during the IVF cycles.
I’d really appreciate your thoughts and advice on this.
Many thanks, and please keep up your fantastic work, us ladies need people like you!


Dear T,
Laparoscopy undoubtedly to gauge the extent of the disease and any adhesions and other pathology. Laparoscopic surgery, yes, if the surgeon is genuinely experienced in this treatment and if the endometriosis is operable. If the pain you are getting is radiating in the way you say, then an MRI might be justified too. A low AMH is often found in people with ovarian endometriosis, by the way. Get these things done before contemplating IVF.

Best wishes
Robert Winston