1. Does surgery for endometriosis improve fertility outcomes? Lakshmi Ravikanti Fellow in Endoscopy and Infertility Waikato Hospital & Fertility Associates Hamilton Acknowledgment: Mr V P Singh

3. Is IVF outcome affected in Endometriosis? Endometriosis Vs Tubal – OR 0.56 Severe endometriosis Vs mild endometriosis-OR 0.60 Barnhart et al.FertilSteril.2002

4. Endometrial Receptivity or Oocyte Quality? Diaz et al. FertilSteril.2000 Healthy Oocyte Donors Healthy recipients Recipients with Endometriosis III-IV No significant difference in implantation rates or live birth rates Sibling Oocytes Uterine receptivity is NOT impaired

5. Endometrial Receptivity or Oocyte Quality? Simon C et al. HumRep 1994 Oocyte donors with endometriosis Vs Oocyte donors without endometriosis Significantly lower pregnancy rates from donors with endometriosis So it is likely to be the Oocyte Quality

7. Expectant management IVF Vs expectant management Soliman et al, Fertil Steril 1993; 59:1239

8. Endometriosis & COH/IUI Tummon IS et al: Fertil Steril 1997;68: 8-12

12. Fertility outcomes after surgery for stage III / IV Endometriosis (unpublished data) 79.7% 20.3% Total no of cases- 261

14. Fertility outcomes after Laparoscopic excision of grade 3 & 4 endometriosis

20. First Laparoscopy

21. Wide excision of deep endometriosis from vagina

22. Excision of D I E from rectum

23. Removal of specimen

24. Excision completed

25. Suturing of vaginal opening

29. THANK YOU