Endometriosis and IVF-ICSI Treatment: Real Patient Cases

Endometriosis is one of the most common and complex conditions in fertility care. Because it is often underdiagnosed, many women do not realise they have it until they face difficulties conceiving. It can affect fertility in several ways — by causing inflammation, adhesions, or blocking the fallopian tubes — and it is often linked to symptoms such as painful or heavy periods.

At EmbryoClinic, many patients only discover endometriosis during fertility investigations, sometimes after months or even years of unsuccessful attempts to conceive. This article shares real patient stories that demonstrate how personalised treatment — from surgery to advanced IVF/ICSI protocols — can make a significant difference.

We will present three real cases that highlight the different ways endometriosis can affect fertility and how, with the right approach and support, many women can achieve their dream of motherhood.

Patient Case Study no. 1

Patient background

This is a case of a 31-year-old woman and her 32-year-old husband, who visited our clinic due to infertility despite regular intercourse for the past 18 months. Both partners were healthy, except for the woman being overweight (BMI 28.7) and having no notable medical history related to infertility up to that point, although the woman did mention that she had been experiencing heavy and painful menstrual periods in the last 2 years.

Diagnostic findings

Routine fertility investigations were performed. Analysis of the husband’s semen revealed no issues. Pelvic ultrasound of the wife revealed no abnormal findings; however, tubal patency assessment via HyFoSy revealed occlusion of the right tube and a patent but stenosed left tube. In order to further investigate the abnormal HyFoSy findings, a diagnostic laparoscopy was performed, which revealed unexpectedly extensive peritoneal endometriosis, which had caused peri-salpingeal adhesions.

Protocols and procedures

Since our Team includes Reproductive Surgery and Endometriosis Surgery Experts, the patient was advised to undergo operative laparoscopy with adhesiolysis and excision of all visible endometriosis foci. This would improve both her fertility prospects and her clinical symptomatology. The operation was performed one month later, with all visible lesions addressed. Chromopertubation tests after the surgery revealed that both tubes were patent. Four months post-operatively, the couple underwent two IUI attempts, which were unsuccessful.

Before the embryo transfer

Finally, the couple opted to undergo ovarian stimulation and IVF, which resulted in the creation of 5 high-quality blastocysts (Gardner Scale: 2x4AA, 2x3AB, 1x5AB).

The embryo transfer

Fresh embryo transfer was performed in the same cycle, with a single 4AA embryo being transferred approximately 8 months after the couple’s initial presentation to our clinic.

After the embryo transfer

The transfer resulted in a positive beta-hCG, and later on obstetrical ultrasound confirmed an intrauterine gestational sac. The woman delivered a full-term healthy baby boy 9 months later.

Clinic’s experience with this kind of case

Endometriosis is a common condition in the general female population, affecting approximately one in ten women, but it is also more pronounced in women with infertility, affecting up to half of them. Women with endometriosis of various degrees of severity are quite common amongst our patients, with several being diagnosed for the first time here, since the clinical symptoms of endometriosis may be subtle.

Doctor’s perspective

Dr Elias Tsakos, EmbryoClinic’s Medical Director:

“This is a common case of endometriosis causing adhesions and affecting ovarian function indirectly. This form of the condition is very common in the clinical context of fertility care. While some cases may manage to achieve success without endometriosis treatment, surgical resolution of the adhesions and removal of endometriosis foci constitutes the recommended treatment option, as both a means of improving chances of conception and of addressing clinical symptoms. Expertise in both Reproductive Medicine and Surgery is required for this treatment option to be safe and effective”.

Patient Case Study no. 2

Patient background

A 34-year-old woman and her 40-year-old partner, both with obesity as a contributing health factor, presented to our clinic with a history of infertility spanning over four years. The female partner had hypothyroidism, which was well-controlled on medication. The couple had previously undergone two IVF attempts elsewhere: one cancelled due to logistical/accessibility issues, and another that progressed to embryo transfer but did not result in pregnancy. They had a known diagnosis of bilateral endometriomas, each over 3 cm in diameter, raising concerns about ovarian response and oocyte quality.

Diagnostic findings

A comprehensive pre-treatment evaluation was performed, including hormonal assessment and ultrasound scan, which showed the presence of bilateral endometriomas, with the left having grown to 3.7 cm. Given their size and the concern for poor follicular access during oocyte retrieval and their impact on ovarian response to stimulation, a surgical consultation was arranged.

Protocols and procedures

Given the presence of bilateral endometriomas—both over 3 cm in diameter—and the progressive increase in size, surgical intervention was recommended to improve ovarian accessibility and stimulation outcomes. The patient underwent robotic excision of both endometriomas, with the surgical team prioritising the preservation of healthy ovarian tissue while removing the cysts as completely and precisely as possible. The procedure was performed without complications. The patient recovered well, resuming normal activity within a week. In line with best practices for post-operative healing and endometrial recovery, a three-month interval was observed before initiating the next ovarian stimulation cycle, allowing the ovaries and endometrium to fully restore optimal function. The patient underwent a standard short stimulation protocol.

Before the embryo transfer

Ovarian stimulation resulted in the collection of five oocytes and the development of two viable blastocysts. A fresh embryo transfer was performed, and the other blastocyst was frozen for a subsequent attempt.

The Embryo transfer

The embryo transfer took place approximately 6 months after the couple’s initial presentation to the clinic. A single fresh embryo transfer of a 3AA blastocyst was performed; however, it resulted in implantation failure. A subsequent attempt two months later was performed, with a single transfer of the other 3AA blastocyst.

After the embryo transfer

The transfer resulted in a positive beta-hCG, and later on obstetrical ultrasound confirmed the presence of an intrauterine gestational sac. The woman is currently in the 7th month of gestation, and her pregnancy has been uneventful.

Clinic’s experience with this kind of case

Endometriomas are a relatively frequent finding among individuals undergoing fertility treatment. In most cases, these cysts are smaller and affect only one ovary, which makes their management more straightforward. However, in more complex presentations—such as bilateral or larger endometriomas—treatment becomes more challenging. Endometriomas often occur alongside other manifestations of endometriosis, compounding the effects on fertility and often intensifying associated clinical symptoms. These factors typically warrant surgical intervention to improve reproductive outcomes and alleviate discomfort.

Doctor’s perspective

Dr Elias Tsakos, EmbryoClinic’s Medical Director:

“This report highlights the value and significance of effective and precise surgical treatment of endometriosis, ovarian endometriosis (endometrioma) in particular, about IVF success. Surgical excision with robotic surgery facilitates effective and total removal of the endometrioma cyst wall, which will prevent or at least delay recurrence, while also ensuring minimal surgical trauma to the surrounding ovarian tissue. This ensures that the ovary is in the best condition possible, during the next ovarian stimulation attempt”.

Patient Case Study no. 3

Patient background

A 32-year-old single woman visited our clinic seeking treatment through a sperm donation program. She had a longstanding desire to conceive and had previously undergone three IVF cycles at other facilities, all of which failed. Her medical background revealed several important risk factors, including severe obesity (BMI: 38.8), hypothyroidism, and pre-diabetes, the latter of which was managed with metformin therapy. Additionally, she reported a history of dysmenorrhea and dyspareunia, symptoms she had experienced for many years but which had never been fully investigated.

Diagnostic findings

Despite her relatively young age, her reproductive history and symptom profile suggested a more complex underlying cause for her infertility. Initial consultations included a comprehensive, three-dimensional transvaginal ultrasound performed by an expert Gynaecological Sonographer at our Clinic, which revealed the presence of severe, deep infiltrating endometriosis in the pelvis, as well as a 2 cm endometrioma on the left ovary. These findings were clinically significant and had likely contributed to both her pain symptoms and her prior treatment failures.

Protocols and procedures

Given the advanced nature of her disease and our clinic’s specialised expertise in reproductive surgery, a robotic laparoscopic excision of the endometriotic lesions was recommended. The goal of the intervention was not only to alleviate pelvic pain and restore pelvic anatomy but also to enhance ovarian response to stimulation and improve the chance of embryo implantation. The patient underwent surgery shortly thereafter. The procedure revealed extensive fibrosis and multiple deep lesions affecting the uterosacral ligaments and posterior cul-de-sac. These lesions were successfully excised using a robotic platform, allowing for precise removal while preserving surrounding structures. The left ovarian endometrioma was also excised with careful preservation of the remaining ovarian tissue.

Before the embryo transfer

The patient’s recovery was uneventful, and she was able to resume normal activities within two weeks. She also noted a significant improvement in her clinical symptoms. Approximately 12 weeks after surgery, and following careful cycle planning, she began ovarian stimulation in preparation for IVF with donor sperm. A standard antagonist protocol was used, with close monitoring due to her recent surgical history and baseline endocrine profile. The stimulation resulted in a good ovarian response and the retrieval of 6 oocytes, with 5 being mature. These were inseminated using donor sperm through IVF, resulting in the development of five high-quality embryos. All five embryos were cryopreserved at the blastocyst stage (Grades: 4AA, 4AA, 4AB, 3AB, 3AB).

The Embryo transfer

Embryo transfer was scheduled for the near future, as the patient wanted to postpone it for personal reasons. Six months after oocyte collection, a frozen-thawed transfer of a single 4AA blastocyst was performed.

After the embryo transfer

The transfer resulted in a positive beta-hCG, and later, the presence of an intrauterine gestational sac was confirmed via ultrasound. The woman is currently in the 4th month of gestation without any notable symptoms or causes for concern.

Clinic’s experience with this kind of case

Endometriosis is a prevalent condition in the general female population and especially in women with infertility. At EmbryoClinic, it is common to encounter patients with varying degrees of endometriosis, although the severity of the described case is a somewhat rarer occurrence. However, given the increasing awareness of the subject of endometriosis and our clinic’s dual expertise in both minimally invasive surgery and fertility treatment, it is highly likely that we will begin encountering more and more women in a similar position.

Doctor’s perspective

Dr Elias Tsakos, EmbryoClinic’s Medical Director:

“The present case highlights the challenging nature of endometriosis in both surgical and fertility treatment. In the present case, the presence of obesity further complicated surgical treatment. However, the use of robotic surgery greatly assisted in the safe and complete excision of all visible endometriosis loci and the atraumatic removal of the endometrioma. The success of the surgical treatment was also evident from the positive reproductive outcomes and improvement of clinical symptoms.”