By Karina Hoan, M.D., gynecology and minimally invasive surgery

Undiagnosed pelvic pain and infertility often share a common but frequently missed cause: endometriosis.

Endometriosis is characterized by the presence of endometrial glands and stroma (connective tissue) outside the uterus. These misplaced tissues trigger chronic inflammation, internal bleeding and scarring, leading to both persistent pain and significant barriers to conception.

Many women endure years of suffering before discovering that their pain and infertility stem from this treatable condition. Fortunately, awareness is increasing. More women are seeking expert care, and for many, advanced surgical techniques provide life-changing relief and dramatically improve fertility outcomes.

Recognizing the symptoms: When to see a specialist

Severe pelvic pain: While mild menstrual cramping is normal, pelvic pain that disrupts daily life, requires frequent pain medication, or confines you to bed is not. This level of discomfort warrants a thorough medical evaluation.

Gastrointestinal distress: Endometriosis-related inflammation can mimic irritable bowel syndrome (IBS), causing bloating, diarrhea and other digestive issues. If these symptoms coincide with your menstrual cycle, endometriosis may be the underlying cause.

Unexplained infertility: If you have been struggling to conceive and you experience other symptoms of endometriosis, a specialist can determine whether this condition is affecting your reproductive health.

Precision surgery for endometriosis

While medical therapies can help manage symptoms, surgery remains the gold standard for effectively treating endometriosis-related pain and infertility. Today’s minimally invasive techniques — conventional and robotic laparoscopy — offer highly precise surgical removal (“excision”) of tissues with minimal recovery time.

Compared to the open surgeries and prolonged recovery periods of the past, today’s laparoscopic techniques allow us to achieve superior outcomes through very small incisions. As a fellowship-trained expert in both conventional and robotic laparoscopy, I use these techniques to optimize excision while preserving and even improving fertility.

During the procedure:

• A high-definition camera is introduced through the belly button, and the abdominal cavity is inflated for an unobstructed view of the pelvic organs.
• Endometriosis lesions, including subtle inflammatory changes that might be missed by an untrained eye, are carefully identified.
• Endometriosis tissues are precisely excised, restoring normal pelvic anatomy, alleviating pain, and enhancing fertility by removing barriers to conception.

Restoring health and fertility: Proven success rates

By removing scarring, reducing inflammation, and restoring normal function to reproductive structures, surgery offers not just symptom relief, but a path to motherhood for many women.

• Pain relief: Studies show that 70 to 85% of women experience significant, lasting relief after the surgical removal of abnormal tissue.
• Enhanced fertility: Laparoscopic excision of mild endometriosis has been shown to nearly double spontaneous pregnancy rates. With reproductive assistance, up to 75% of women who undergo excisional surgery conceive.

One patient’s success story

Toward the end of 2024, a patient came to me who had been trying to conceive since the previous June. She had lived with chronic pelvic pain for years, seen multiple providers, and even undergone a surgical procedure, but with no answers or results.

After a thorough workup, I explained her options, and we scheduled a minimally invasive robotic surgery for Dec. 2. During the procedure, I diagnosed and resected stage 3 endometriosis, and also removed five uterine polyps.

“The relief was almost immediate,” she wrote to me afterward. “My pelvic pain, which had become a part of daily life, was finally gone.” Just a few months later, she experienced her first-ever positive pregnancy test.

“Words can’t fully capture how grateful I am,” she wrote. “I feel relieved, excited, and incredibly hopeful for the future.”

Talk to a specialist: We’re here to help

If you are experiencing persistent pelvic pain or struggling with infertility, consult a specialist in endometriosis treatment. With today’s advanced techniques and surgical precision, endometriosis no longer has to dictate your future.

Relief is possible. Fertility can be restored. With expert care, the path to healing — and even motherhood — may be closer than you think.

Read Dr. Hoan’s related articles: Put an end to pelvic pain, and Q&A: Endometriosis