Treating endometriosis - IVF or surgery ?

It is understandable that patients with endometriosis get confused while exploring their treatment options, because there are so many choices. When they get different opinions, they may feel that the doctor is cheating them or hiding information from them. However, doctors will often differ, because medicine is not an exact science - and just because the new doctor has a different opinion does not mean that old doctor was a cheat or a quack or a charlatan ! Reviewing the literature can be very confusing, because there is so much confusion about this common and perplexing disease, which has been called a riddle wrapped in an enigma !

 

For example, a patient with endometriosis will go to a gynecologist who may advice her to do laparoscopy for diagnosis and treatment of the disease. Such a patient may be understandably uncomfortable with the prospect of subjecting herself to surgery, thereby prompting her to seek a second opinion from another gynecologist. If the second gynecologist also advices her to go for a laparoscopy, she will feel that she is on the right track and go ahead and with laparoscopy. Unfortunately this kind of thinking is flawed. The problem is that when you have a hammer, you end up seeing only nails! Most gynecologists respond in a reflexive manner when they hear the word endometriosis, with their standard advice being laparoscopy to remove endometrial lesions. Their universal view seems to be that endometrial deposits cause fertility problems; and that any abnormality the best thing to do is to just remove it -just like all lumps on the breast need to be removed.

It is quite easy to sell the patient the idea of doing a laparoscopy because for one, it makes logical sense. Is it not important for a doctor to take a look inside the belly in order to see exactly what’s going on? Most doctors also emphasize how easy laparoscopic surgery is today and how it doesn’t leave a scar, takes a few hours and the patient doesn’t even need hospitalization because it is “minimally invasive surgery”.  

This is why a lot of patients end up doing surgery and the surgery actually reduces their fertility. This occurs in cases where endometriosis is minor because it was just a red herring which wasn’t really affecting her fertility and which could have been safely left alone. However, once a doctor is in the OR (Operation Room), he has to complete what he started. Along with removing the chocolate cyst, he also removes normal ovarian tissue, thus reducing the patient’s ovarian reserve, consequently causing her to become infertile!

This is the biggest tragedy in going to two doctors of the same specialty for a second opinion. In most cases, they share the same world view; and their advice is likely to be the same. This is why you should seek a second opinion from with a different perspective, that way you will get a much more balanced viewpoint thereby enabling you to understand both the pros and cons of a given option. Ideally you should seek out an IVF specialist, who will try to convince you why you should not be doing a laparoscopy and choose IVF instead.

This is why going to an alternative medicine practitioner can also be very helpful - they have a very different world view !

 

Ultimately, different points of view may leave you a little confused since it makes it difficult to determine what’s right. However, it is better to be confused because you know a lot rather than make wrong decisions out of lack of information. Such ignorance can haunt you afterwards. 

If a doctor prescribes a surgery, then one of the questions you should ask him is – give me good reasons why I should not do the surgery! A good doctor will understand your question and answer you appropriately; explaining the pros and cons of the process and justifying his advice. Unfortunately, some doctors will get agitated and upset when they feel you are trying to ‘question their authority’.

If a doctor gets angry because you ask questions, then it means that the doctor is not confident about his opinion and you would be better of finding another doctor who can give you a more thoughtful, rational and well-reasoned opinion; and with which you can be comfortable. If you find yourself scared of asking your doctor questions, it means that there is something wrong with your relationship with him and therefore you need to get things fixed before matters get worse. If the doctor makes you feel uncomfortable when you ask questions, this means the chemistry between you and the doctor is not right.  A good doctor values a patient’s questions and will always do his best to answer them respectfully!