Send us a text with a question or thought on this episode ( We cannot replay from this link)
IVF can feel like a cruel tradeoff when you’re living with endometriosis or adenomyosis: you’re doing something hopeful for your fertility, and suddenly your pelvic pain ramps up. We sit down with Dr. Sadikah Behbehani, an OBGYN and reproductive endocrinologist trained at McGill University and the Mayo Clinic, to explain why this happens and what it actually means for your long-term endometriosis plan.
We talk through the two biggest drivers of IVF pain flares. First, endometriotic implants can be packed with hormone receptors, so the very high hormone levels used in ovarian stimulation can make those lesions more inflammatory. Second, the ovaries physically enlarge during stimulation, which can pull on ligaments and irritate areas where endometriosis sits near the ovaries. Dr. Behbehani also shares a reassuring point: while symptoms can worsen temporarily, there isn’t data showing IVF makes endometriosis “spread” to a higher stage.
Then we get practical about strategy. Should you do egg retrieval before endometriosis surgery, or clear disease first to protect quality of life? We cover what happens to AMH (anti-Müllerian hormone), why egg count often drops after endometrioma surgery even with careful technique, and why age remains the strongest predictor of egg quality and pregnancy success. If you’re balancing pain, timelines, and tough decisions about repeat IVF cycles, this conversation is built to give you clarity you can bring straight to your doctor.
Subscribe for more quick, expert-led answers, share this with someone navigating endometriosis and IVF, and leave a review so more people can find the show. What question do you want us to tackle next?
Website endobattery.com
Quick Connect Format And Disclaimer
SPEAKER_00
0:00
Life moves fast, and so should the answers to your biggest questions. Welcome to Indo Batteries Quick Connect, your direct line to expert insights. Short, powerful, and right to the point. You send in the questions, I bring in the experts, and in just five minutes, you get the knowledge you need. No long episodes, no extra time needed. And just remember, expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in, and let's quickly get you the answers. I'm your host, Alana, and it's time to connect.
Meet The Fertility And Surgery Expert
SPEAKER_00
0:39
Today I am joined by Dr. Sidika Bebehani, an OBGYN specializing in reproductive endocrinology, infertility, and minimally invasive gynecologic surgery. Dr. Bebehani completed her training at McGill University and the Mayo Clinic, making her uniquely trained in both fertility treatment and complex pelvic surgery. Her work focuses on helping patients navigate conditions like endometriosis and fibroids while preserving and optimizing fertility outcomes. She's also the associate professor at the University of California Riverside School of Medicine and is deeply involved in women's health research, education, and advocacy. Please help me in welcoming Dr. Sudika Bebahani.
Why IVF Can Increase Endo Pain
SPEAKER_00
1:22
One of the things that I have heard on multiple occasions is when women with endometriosis or a domiosis go into the office and get IVF, pain is heightened. And I don't know if that's because of the medication they're using. We hear this often in this space, right? Like I went in for IVF and I maybe had a little pain. And then after IVF, my symptoms got significantly worse with the IVF treatment. Can you explain why that might happen for those people that are considering that?
SPEAKER_01
1:55
Yeah, unfortunately, that's absolutely true. A lot of women will have more pain after their IVF cycles. And it's because those endobetriotic deposits have all those receptors that respond to hormones. And when you're doing IVF, your body's being exposed to supraphysiological levels of hormones, so really high levels, and that can trigger the implants to become more inflammatory. However, there's no data to say your endo will become more advanced, so at higher stage, or spread because of the IVF treatment, which is reassuring. And that allows us to actually treat women with IVF to help retrieve eggs first before we do surgery, especially if we're worried about the egg count dropping after surgery. So I always tell my patients not to worry about their endo getting worse after IVF because we have a plan. We're gonna get rid of it anyway. But their periods may be more painful because those implants are there, they're sucking up all the hormones, they're responding to all those hormones, and first period after IVF may be one of their worst periods ever. First period after surgery can also be really bad. But with IVF, sometimes you have to do more than one cycle. So I have patients who say, Doctor, I can't do this anymore. My period was really bad. I don't want to go through another IVF cycle. They also feel very bloated, very crampy during the IVF cycle because of all those elevated hormones. The ovaries are stretching with IVF, they're pulling on all those ligaments. If there's endometriosis around the ovaries, you're actually making that endostretch and rub against the ovary, which can elicit pain too. So during IVF, it can make pain worse. But the good thing about it is that it's usually a quick process. Usually we're done in two weeks. And the first four or five days, the ovaries are still slowly responding. It's usually the last week of the IVF cycle where it can be really bothersome and annoying. But if it helps us get the eggs, then again, I think it's worth it, knowing that we have a plan.
Retrieval First Versus Surgery First
SPEAKER_01
3:47
This is not going to go on forever. As soon as the eggs are out, as soon as the embryos are created, we are going to do surgery to get rid of the endometriosis and reset the clock. But again, I listen to my patients. If someone says I cannot do this, this is one and done. I cannot go through another IBF cycle, then I respect that. And we come up with other ways to do it. Maybe we should do surgery first, clear out all the endo, then do IVF so that their pain is not triggered by their IBF cycle.
Surgery Impact On AMH And Egg Count
SPEAKER_00
4:11
Yeah. Well, okay, so when you're talking about doing egg retrieval, is there evidence to point to egg quality in egg count being affected by not only the endometriosis but by uh the surgery?
SPEAKER_01
4:25
Egg count for sure, unfortunately, regardless of how careful we are around the ovaries. And again, I'm a fertility doctor, so no one loves and treasures those ovaries more than I do. I have a really hard time taking out an ovary and someone who may not even need it because I'm like, this ovary is so precious. We work so hard to be closed. But anyway, I try my very best to reduce the damage to the ovary. We use surgical techniques to reduce blood loss, reduce trauma. We're very gentle with our dissection, but despite our best efforts, peeling a cyst from the ovaries always going to cause a drop in the egg count. So the number of eggs after surgery, and as reflected by an AMH, so usually people get an anti malarian hormone level, an AMH level, AMH will always drop after surgery. The quality of the egg is a different story. Again, I go back to saying age is the most important determinant of pregnancy. So when you're young, you're gonna have better eggs. When you're older, you're going to have lower quality eggs. How long is this surgery going to delay our IVF? Are we going to wait six months in someone who's 41 before we do an egg retrieval? Then I would say age is going to ruin any improvement we may have in egg quality from surgery. Or are we talking about a 25-year-old where when we do surgery, she potentially could get better quality eggs because her eggs were never as good as a 25-year-old's eggs should be. And I see that often with endometriosis patients. You see a really great AMH, they come to see me with an AMH of two, and we say, amazing. Two is great. Two means 20 eggs in a healthy woman. You stimulate this endo patient and you only get five or six eggs. Doctor, what happened? My AMH is really good. It's because the endometriosis is suppressing your ovary. It's not letting your ovary respond to its full potential. Now we get rid of the endo with surgery and we do another IBF cycle and we still get six eggs. But the AMH dropped from two to one. But now that's a more appropriate response. Now your ovary is actually giving you everything it has. So the number of eggs retrieved post-surgery may not change as much depending on how you responded pre-surgery. But if pre-surgery we were struggling to get two or three eggs, I would try and get as many eggs as I can before surgery because I'm concerned after surgery, the three eggs will become one egg. And that can make a big difference when it comes to embryo creation. However, in women who've had IVF, their ovaries are not doing as well as they should. We should not just keep pushing and pushing more IVF. We need to do something different. So then we do surgery and repeat IVF again, given that they're in an appropriate age to do so. When you're older, we should just get as many eggs as we can
Timing After Surgery And Closing CTA
SPEAKER_01
7:10
as soon as possible. We don't want to delay things. And sometimes that's possible and other times it may not be. If they have really large cysts or endometriomas on their ovaries and we really can't access the ovaries, then I tell them, let's do surgery ASAP because I need you to recover from surgery so we can do the egg retrieval. And I usually recommend waiting about six weeks. There's no data to support that. We don't know what the ideal period of waiting is. We just theoretically want to wait for all the suppression from stress to be gone before we stimulate the ovary. And we don't want to wait too long because then we don't want to risk the endo endometriomas, the cyst on the ovary coming back, as we know every month a woman ovulates is an opportunity for a cyst to grow. And then we also want to take the age factor into account.
SPEAKER_00
7:54
That's a wrap for this quick connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming. Send them in, and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at Indobattery.com or visiting the Indobattery.com contact page. Until next time, keep feeling empowered through knowledge.