Dr. Aimee Eyvazzadeh, also known as The Egg Whisperer, recently welcomed Dr. Karli Provost Goldstein to The Egg Whisperer Show for an in-depth discussion on endometriosis, fertility, and surgical treatment options. As a board-certified minimally invasive gynecologic surgeon, Dr. Goldstein specializes in fertility-restorative surgery and advanced excision techniques for endometriosis.

Their conversation covered the challenges of diagnosing endometriosis, the impact of the disease on fertility, and the importance of seeking expert care for effective treatment.

Here are the top five takeaways from this insightful discussion.

1. Endometriosis is Often Misdiagnosed or Overlooked

Endometriosis remains widely underdiagnosed, with an average 10-year delay before patients receive a proper diagnosis. One of the biggest challenges is that early-stage endometriosis does not always appear on imaging such as ultrasounds or MRIs. Many women with painful periods or unexplained infertility are placed on birth control or other hormonal medications without a definitive diagnosis. The only way to confirm endometriosis is through laparoscopic surgery, ideally performed by a specialist trained in excision surgery.

2. Excision Surgery is the Gold Standard for Treating Endometriosis

Not all surgeries for endometriosis are created equal. Many patients undergo ablation surgery, where lesions are burned but not fully removed, leading to persistent symptoms and higher recurrence rates. Dr. Goldstein emphasized the importance of excision surgery, where the disease is completely cut out, reducing inflammation and improving fertility outcomes.

Patients seeking surgery should ask their surgeon:

• How many endometriosis surgeries they perform per year
• Whether they perform excision or ablation
• If they collaborate with colorectal and urology specialists for advanced cases
• How long their surgeries typically last (thorough excision usually takes at least 1.5–2 hours)

3. Endometriosis is a Leading Cause of Unexplained Infertility

Up to 50% of women with unexplained infertility have endometriosis. Even in women with no obvious pain symptoms, silent endometriosis can cause:

• Inflammation in the pelvic cavity
• Poor egg quality
• Implantation failure
• Tubal scarring or adhesions

Dr. Goldstein and Dr. Aimee discussed how ultrasound clues such as a retroverted uterus, ovarian adhesions, or endometriomas (chocolate cysts) may indicate the presence of endometriosis, even when patients are not experiencing severe symptoms.

4. Surgery is Not the Only Approach – Holistic and Hormonal Options Exist

While surgery is the only way to remove endometriosis completely, some patients prefer non-surgical management or want to delay surgery. Dr. Goldstein highlighted several alternative approaches, including:

• Continuous birth control or hormone therapy to suppress symptoms
• Acupuncture and pelvic floor therapy for pain management
• An anti-inflammatory diet to reduce symptoms
• Stress management techniques like yoga, breathwork, and hypnotherapy

Although these approaches can help manage symptoms, they do not remove the disease itself.

5. Fertility Preservation Should Be Considered for Women with Endometriosis

Endometriosis can accelerate ovarian aging, making fertility preservation a key consideration for many women. Dr. Goldstein strongly recommends that young patients with endometriosis discuss egg or embryo freezing before undergoing surgery.

Key factors to consider include:

• Checking AMH levels before surgery to assess ovarian reserve
• Coordinating surgery and fertility treatments to optimize outcomes
• Timing excision surgery carefully to remove endometriomas while preserving as much ovarian tissue as possible

Looking Ahead

Dr. Aimee and Dr. Goldstein’s conversation reinforced the importance of early diagnosis, expert treatment, and a multidisciplinary approach to managing endometriosis and fertility. Women experiencing chronic pelvic pain, unexplained infertility, or persistent symptoms should seek care from a specialist trained in excision surgery and fertility-focused gynecologic care.

For more information on Dr. Karli Provost Goldstein’s work in minimally invasive excision surgery and fertility-restorative care, visit ESSE Care & Wellness.