Endometriosis, often overlooked in fertility treatments, is a key contributor to recurrent miscarriages and infertility, yet it remains undiagnosed in many cases. While fertility clinics focus heavily on factors like egg quality and hormone levels, the structural and inflammatory impacts of endometriosis are often neglected, even though they play a significant role in pregnancy loss. Even in its subclinical form, endometriosis can disrupt implantation and increase the risk of miscarriage. A comprehensive treatment strategy that includes excision surgery and hormone therapy is crucial for improving pregnancy outcomes.

The Structural and Inflammatory Impact of Endometriosis

According to Dr. Sanjay Patel, an expert in endometriosis surgery, fertility specialists often overlook the structural and inflammatory effects of endometriosis. “Endometriosis is perhaps the most underdiagnosed cause of repeated miscarriage. Fertility clinics tend to focus exclusively on egg quality and hormone levels, ignoring the underlying structural and inflammatory problems that impair pregnancy," he explains.

One of the complications that Dr. Patel frequently sees in patients with endometriosis is adenomyosis, a condition that often accompanies endometriosis. Adenomyosis causes the uterine tissue to become thickened and hardened, making the uterus more prone to contractions, which increases the chances of miscarriage. This combination of structural abnormalities and inflammation can significantly disrupt the environment needed for successful pregnancy.

Even in cases where patients report minimal or no pain, silent or mild endometriosis can still affect fertility. “Even small amounts of uterine inflammation can create an unfavorable environment for implantation," Dr. Patel notes. He emphasizes that while excision surgery is the most effective treatment for endometriosis, it must be performed correctly. Many gynecologists leave behind disease remnants, allowing inflammation to persist and continue affecting the uterus’ receptivity for pregnancy.

Beyond IVF: A Holistic Approach to Treatment

While in vitro fertilization (IVF) is often offered as a solution for infertility caused by endometriosis, Dr. Patel cautions that IVF alone is not a cure for the underlying condition. "Ongoing inflammation in the endometrium, which is a direct result of untreated endometriosis, can continue to cause miscarriages," he explains. IVF may help with conception, but it does not address the root cause—endometriosis-related inflammation—leading to potential miscarriage down the line.

Dr. Patel suggests that the best outcomes are achieved with a multidisciplinary treatment approach that combines excision surgery, hormone therapy, and fertility treatment. Treating endometriosis in a holistic manner—by addressing both the structural and inflammatory components—can significantly enhance pregnancy rates and reduce the emotional toll of repeated pregnancy loss.

Endometriosis as a Systemic Disease

Dr. Smeet Patel, an endometriosis specialist at Mayflower Women’s Hospital in Ahmedabad, emphasizes that endometriosis is not simply a reproductive disorder; it is a systemic disease that affects multiple body systems. “Endometriosis is a complex endocrine and immune disease that disrupts the essential processes needed for a successful pregnancy," he explains.

Endometriosis can cause progesterone resistance, immune system disruption, and persistent inflammation, all of which contribute to an unfavorable environment for conception. As a result, many women with endometriosis struggle with implantation failure and recurrent pregnancy loss.

Further complicating matters, conditions like Deep Infiltrating Endometriosis (DIE) and adenomyosis contribute to uterine dysfunction, which can make it more difficult to maintain a pregnancy. These conditions can cause abnormal uterine contractions and structural deformities, making the uterus less receptive to the embryo, which in turn affects implantation and gestation.

Dr. Patel stresses the importance of comprehensive screening for endometriosis in cases of unexplained infertility or recurrent pregnancy loss. Without a proper diagnosis, patients may undergo treatment for years without addressing the root cause of their fertility struggles. “Failure to recognize this systemic disorder can delay appropriate treatment and reduce the chances of conception,” he warns.

The Role of Excision Surgery

Excision surgery remains the gold standard for treating endometriosis, as it directly removes disease tissue, alleviates inflammation, and restores hormonal balance. Dr. Smeet Patel explains, “Excision surgery is the most effective intervention for improving uterine receptivity and creating a better environment for implantation. When done correctly, it can significantly enhance the chances of a successful pregnancy."

However, the benefits of excision surgery are maximized when combined with a comprehensive treatment plan that includes hormone regulation and personalized fertility management. Dr. Patel stresses that successful outcomes require an integrative approach that combines surgical intervention with ongoing fertility treatment and hormonal support to ensure the best possible results for the patient.

The Need for Greater Awareness

Dr. Smeet Patel also highlights the necessity of greater awareness surrounding the role of endometriosis in recurrent miscarriage. “When patients experience repeated miscarriages with no clear explanation, endometriosis should always be considered and screened for," he advises. Proper diagnosis followed by focused excision surgery can dramatically improve uterine receptivity and pregnancy outcomes, providing renewed hope for women struggling with infertility and recurrent pregnancy loss.

Endometriosis is not just a fertility issue; it is an independent disease that requires active, research-based intervention. By taking a more integrated approach to treatment, healthcare providers can help reduce miscarriage rates and improve the chances of a successful pregnancy for women affected by this often-overlooked condition.

Endometriosis is a complex condition that affects not only fertility but also overall health. As a hidden contributor to recurrent miscarriage, it is crucial for healthcare providers to look beyond traditional fertility treatments and address the structural and inflammatory impacts of endometriosis. By combining excision surgery, hormone therapy, and personalized fertility treatment, women with endometriosis can improve their chances of a successful pregnancy. Greater awareness and a holistic approach to treatment will be key to reducing the emotional and physical toll of repeated pregnancy loss, offering hope to those affected by this often-misunderstood condition.