Many women with endometriosis are told to book surgery right away. Far fewer are told that the operation itself can cost them part of their ovarian reserve. That gap in information leads to decisions that cannot be undone. Before you sign a consent form, there are seven things worth knowing.
These points come from a video by Dr. Sophia Umair Bajwa, a fertility specialist at Family Fertility & IVF Center in Lahore. She covers AMH levels, the role of surgery and the right time to move to IVF. Read the points in order, because each one builds on the last. By the end, you will know exactly which questions to put to your doctor.
1. Endometriosis Lowers AMH Only Slightly
AMH, short for Anti-Müllerian Hormone, is a blood marker linked to ovarian reserve. Many patients fear that endometriosis wipes it out. It does not. Dr. Bajwa explains that the usual reduction is modest, somewhere between 7% and 10%.
Why does this matter? Panic often drives rushed choices. A small dip in AMH is not a reason to skip careful planning. It is a reason to measure the number and keep track of it over time.
2. Surgery Is Not Always Required
Endometriosis and surgery are so often mentioned together that people assume one demands the other. In reality, many women never need an operation. Some conceive naturally, and others go straight to IVF at the right moment. Surgery is one tool, not the default.
This changes how you should read advice. If a doctor recommends an operation, ask for the reason. A good answer will refer to your scans, your symptoms and your goals. A vague answer deserves a second opinion.
3. Three Situations Make Surgery Worth Considering
Surgery does have a place. According to Dr. Bajwa, it should be considered when the endometriosis cysts are large. It also makes sense when pain is severe and affects daily life. A third case is when other treatments, including IVF, are not possible for the patient.
If none of these fit your situation, an operation may add risk without adding benefit. Still, the final call depends on a full assessment. Your scans and history matter more than any general rule.
4. Laparoscopy Is an Option to Consider
When an operation is truly needed, the technique makes a real difference. Dr. Bajwa advises a laparoscopic approach, often called keyhole or laser surgery. The surgeon works through tiny incisions and watches the ovary on a magnified screen. That clear view helps protect healthy tissue while the cyst is dealt with.
Recovery is another factor. Smaller cuts usually mean less discomfort afterward. Many patients return to normal routines sooner than they would after open surgery.
5. The Surgeon Should Be a Fertility Specialist
This is the point many patients never hear. Surgery for endometriosis should be performed by a fertility specialist, not by a general surgeon or a general gynecologist. The reason is simple. Ovaries are delicate, and a surgeon without fertility training may remove or damage healthy tissue without meaning to.
That damage cannot be reversed. So before booking, ask a direct question: “Do you operate with my future pregnancy in mind?” Family Fertility & IVF Center in Lahore is built around fertility care, which means ovarian protection shapes every surgical decision made there.
6. Test Your AMH Before Any Operation
Of all the points in the video, this one is the easiest to act on. Check your AMH level before surgery, not after. An operation can remove a small amount of healthy ovarian tissue along with the cyst. A pre-surgery result shows what you are starting with.
Without that baseline, you cannot judge how surgery changed your reserve. Your doctor also loses a key piece of planning data. It is one blood test, and it can shape the whole treatment path.
7. A Low AMH May Mean Considering IVF
Suppose your AMH comes back low. In that case, Dr. Bajwa generally advises against surgery and recommends going directly to IVF. It sounds backwards, since surgery feels like the active fix. But the priority is to protect the ovarian reserve you still have.
Every operation carries some risk of tissue loss. When reserve is already limited, that risk weighs more heavily. IVF avoids it altogether.
What to Know About IVF
Some women try to conceive naturally for a period, either before or after surgery. If pregnancy does not happen, IVF is the recommended next move. Timing depends on age, AMH and how long you have been trying. A fertility specialist can help you decide when to stop waiting and start treatment.
Be Careful With Fertility Medicines
Here is a detail that surprises many patients. If active endometriosis cysts are present, fertility medicines can trigger them to come back. Starting a stimulation cycle without checking the cysts first can create new problems. A pre-treatment ultrasound helps avoid this. Always confirm your cyst status before any injections begin. If cysts are found, your doctor may delay treatment or adjust the plan. This short pause protects both your ovaries and your chances in the cycle that follows.
Start With the Right Tests
Begin with an AMH test and a pelvic ultrasound. Together, they show your ovarian reserve and the size of any cysts. These results turn a confusing situation into a set of clear facts. Every good treatment plan starts here. Ask for printed copies of your reports. Having them on hand makes second opinions faster and keeps your records in one place. It also helps you notice changes between visits.
Choose the Right Treatment for Your Situation
Small cysts and manageable pain may call for monitoring or natural attempts. Large cysts or severe pain may justify laparoscopic surgery by a fertility specialist. A low AMH generally favors IVF over surgery. Your own numbers, not a general rule, should decide the path.
Reassess as Things Change
Plans can shift. Months of trying, new scan results or a change in symptoms may all call for a fresh look. Regular reviews prevent wasted time and unnecessary procedures. They also keep your treatment tied to your current situation.
Conclusion
Endometriosis affects fertility, but its effect on AMH is modest. Surgery is not always necessary. When it is, it should be laparoscopic, and a fertility specialist should perform it. Test your AMH first, and if the result is low, consider IVF. Keep in mind that every woman’s case is different. A plan that suits one patient may not suit another, even with similar scan results. That is why a personal assessment always comes before a final decision.
Patients who want a clear plan can book a consultation at Family Fertility & IVF Center in Lahore. One visit can show whether surgery, natural attempts or IVF fits your case best.
Learn More
Dr. Sophia Umair Bajwa walks through all of this in her YouTube video, and it is worth watching before you decide on a treatment. Have a question about endometriosis that we did not cover? Leave a comment here or under the video, and we will take it up in a future post.