Endometriosis surgery in Hyderabad involves laparoscopic (keyhole) removal or ablation of endometriosis implants, adhesions, and endometriomas (chocolate cysts). At Mother Hospitals, Boduppal, we perform fertility-preserving endometriosis surgery combined with IVF support for women trying to conceive. Led by Dr. E. Prashanthi Reddy. Call 97059 93366.
Chronic pelvic pain. Chocolate cysts. Failed IVF. Endometriosis can be at the root of all three. At Mother Hospitals, Boduppal, we offer fertility-preserving laparoscopic endometriosis surgery — led by Dr. E. Prashanthi Reddy.
MBBS, DGO, PG Diploma in ART – Kiel University, Germany | 20+ Years Experience | TGMC Reg: 50624
Endometriosis is a chronic, inflammatory gynaecological condition in which tissue similar to the uterine lining (endometrium) grows outside the uterus — most commonly on the ovaries, fallopian tubes, pelvic peritoneum, and sometimes the bowel, bladder, or rectum. This ectopic tissue responds to the hormonal cycle just like the uterine lining — thickening and bleeding each month — but with no way to exit the body. The result is pain, scarring, adhesions, and, in many cases, infertility.
Endometriosis affects approximately 1 in 10 women of reproductive age worldwide and is found in 25–50% of women with infertility. Despite its prevalence, the average delay from first symptoms to diagnosis remains 7–10 years in many countries — including India. Many women are told their pain is "normal" or treated for other conditions before endometriosis is correctly identified.
The American Society for Reproductive Medicine (ASRM) classifies endometriosis into four stages based on the location, size, and depth of implants, as well as the presence and severity of adhesions:
Stage I (Minimal): Small, superficial implants. No adhesions. Usually minimal pain.
Stage II (Mild): More and deeper implants. Still no significant adhesions.
Stage III (Moderate): Multiple deep implants. Small endometriomas on one or both ovaries. Some adhesions around tubes or ovaries.
Stage IV (Severe): Large endometriomas (chocolate cysts). Extensive adhesions involving ovaries, tubes, and sometimes bowel or bladder. Often severe pain and significant infertility impact.
Note: Stage does not always correlate with pain severity. Some Stage I patients have severe pain; some Stage IV patients are nearly asymptomatic.
These two conditions are often confused but are distinct:
Endometriosis: Endometrial-like tissue growing outside the uterus — on ovaries, tubes, peritoneum. Causes pelvic pain and infertility.
Adenomyosis: Endometrial tissue growing within the uterine muscle (myometrium). Causes a bulky, tender uterus, heavy periods, and painful cramping. Diagnosed by MRI or transvaginal ultrasound. Cannot be surgically excised without hysterectomy — managed medically or with IVF directly.
Both conditions can coexist in the same woman — up to 30% of women with endometriosis also have adenomyosis. Dr. Prashanthi will assess for both conditions with ultrasound and, where needed, MRI before planning treatment.
Not all endometriosis requires surgery. The decision to operate depends on symptoms, size of disease, fertility goals, and response to hormonal treatment. Here is a clinical guide:
All surgeries at Mother Hospitals are performed laparoscopically (keyhole) — using 3–4 small incisions and a camera — avoiding large open abdominal cuts, and enabling faster recovery.
Excision (cutting out) of endometriosis implants is considered the gold standard treatment for endometriosis, delivering the best long-term pain relief and lowest recurrence rates. The surgeon precisely cuts around each implant and removes it completely — including the root — rather than just treating the surface. Published evidence (Cochrane Review 2014; ESHRE Guideline 2022) confirms excision is superior to ablation for Stage III–IV disease and for deep infiltrating endometriosis. It requires higher surgical skill but provides more durable results.
Ablation destroys endometriosis implants using heat energy (diathermy, laser, or argon beam coagulator) rather than cutting them out. It is a quicker procedure and appropriate for superficial (Stage I–II) endometriosis implants. However, ablation has a higher recurrence rate than excision because it treats only the surface of the implant, leaving root tissue behind. The randomised controlled trial data (LUNA trial; Abbott et al.) confirm that ablation provides good short-term pain relief for superficial disease but inferior outcomes to excision for deep disease. Dr. Prashanthi will determine which technique or combination is most appropriate for your stage and fertility goals.
Endometriomas — also called chocolate cysts — are endometriosis cysts on the ovaries filled with old, dark blood. Surgical removal involves carefully stripping the cyst wall from the normal ovarian tissue (cystectomy). This is preferred over draining or ablating the cyst, which has very high recurrence rates. The surgical challenge is to remove the cyst completely while preserving as much healthy ovarian tissue as possible, protecting the woman's ovarian reserve. Studies show even carefully performed cystectomy reduces AMH by approximately 30% on the operated side — which is why the decision to operate on endometriomas requires careful discussion of fertility timing, IVF plans, and the alternative of proceeding directly to IVF without surgery.
Severe endometriosis causes adhesions — bands of scar tissue that bind the ovaries to the uterus, the tubes to surrounding structures, or organs together (the "frozen pelvis" in extreme cases). Adhesiolysis — the careful surgical separation and removal of these adhesions — restores normal pelvic anatomy, improves pain, and may allow egg retrieval to be performed safely for IVF. It requires meticulous technique to avoid damage to underlying structures. At Mother Hospitals, adhesiolysis is performed as part of the endometriosis surgery procedure, not as a separate operation.
Transvaginal ultrasound to map endometriomas and assess ovarian reserve. AMH blood test if fertility is a concern. MRI pelvis for suspected deep infiltrating endometriosis (DIE) or bowel involvement. Pre-anaesthesia fitness review. Pre-operative counselling with Dr. Prashanthi to review findings, discuss surgical plan, fertility implications, and post-operative care. Consent obtained covering the procedure, risks, and benefits.
Performed under general anaesthesia. Three or four small incisions (5–10 mm) are made — one at the navel for the camera (laparoscope), and two or three small working ports. The pelvis is inflated with CO2 gas to create a clear working space. Dr. Prashanthi systematically inspects the entire pelvis — uterus, tubes, ovaries, peritoneum, pouch of Douglas, and bowel surface. Endometriosis implants are excised or ablated. Endometriomas are carefully stripped from ovarian tissue. Adhesions are divided. Tubes may be assessed for patency (dye test). Operating time: 45–90 minutes for most cases; longer for severe Stage IV disease. A histology sample is sent for biopsy confirmation of endometriosis.
Most patients are discharged within 1–2 days after laparoscopic endometriosis surgery. On Day 1, light diet is resumed and you will be encouraged to walk short distances. Post-operative pain is managed with oral analgesics. Shoulder tip discomfort from residual CO2 gas is common and usually resolves within 24–48 hours. Return to desk work is typically possible within 7–10 days. Heavy lifting, vigorous exercise, and intercourse should be avoided for 4 weeks. A post-operative review with Dr. Prashanthi is scheduled at 2–3 weeks.
For Stage I–II endometriosis in women trying to conceive naturally, a landmark RCT (Marcoux et al., NEJM 1997) demonstrated that laparoscopic excision and ablation significantly improved pregnancy rates compared to diagnostic laparoscopy alone. For Stage III–IV disease with endometriomas and adhesions, surgery to restore normal anatomy has been shown to improve natural conception rates and IVF outcomes by improving egg access and pelvic environment. However, surgery on endometriomas carries a risk of reducing ovarian reserve — a key reason why the decision must weigh the fertility benefit against the potential loss of follicles.
This is one of the most nuanced decisions in reproductive medicine. Current evidence and ESHRE 2022 guidelines suggest:
Surgery first if: endometrioma is >4 cm (impairing egg retrieval or masking ovarian reserve), severe pain is the primary complaint, or a diagnostic confirmation of endometriosis is needed.
IVF first if: endometrioma is <4 cm and accessible, ovarian reserve is already reduced (low AMH), the woman is older (>36), or previous surgery has already been performed. Each additional surgery on the same ovary carries cumulative risk to reserve. Dr. Prashanthi takes an individualised approach — there is no single correct answer for all women.
Women who have had endometrioma cystectomy — particularly bilateral surgery — are at risk of reduced ovarian reserve and premature ovarian insufficiency later in life. For younger women who have not yet completed their family, egg freezing after endometriosis surgery (once the ovaries have recovered, typically 3–6 months post-op) is strongly worth considering. It protects future fertility in case of recurrence requiring further surgery. Dr. Prashanthi can discuss egg freezing after endometriosis surgery as part of your post-operative fertility planning consultation.
For many women, the question is whether to try hormonal treatment first or proceed to surgery. Here is a structured comparison:
Endometriosis is a chronic, oestrogen-dependent condition and recurrence after surgery is well-documented. Published recurrence rates are approximately 20–30% at 5 years and up to 50% at 10 years for women who do not receive post-operative hormonal suppression. However, recurrence rates are significantly lower with:
Dr. Prashanthi will discuss a personalised post-operative plan including hormonal suppression, fertility timeline, and follow-up schedule at your post-operative review.
The cost of laparoscopic endometriosis surgery in Hyderabad varies depending on the stage of the disease, the complexity of the procedure (excision vs ablation, presence of large endometriomas, severity of adhesions), duration of hospitalisation, and anaesthesia fees. As costs vary significantly by case, we do not publish a fixed price. Please contact us for a personalised cost estimate after your consultation and ultrasound assessment.
Dr. E. Prashanthi Reddy completed her PG Diploma in ART at Kiel University, Germany, bringing European standards of laparoscopic gynaecological surgery to Boduppal, Hyderabad. Her training encompasses both surgical endometriosis management and fertility preservation.
Every endometriosis surgery at Mother Hospitals is performed with fertility preservation as a priority. We use meticulous technique to conserve healthy ovarian tissue during cystectomy, minimise adhesion formation with anti-adhesion barriers, and plan the surgical approach in coordination with your IVF timeline.
Unlike a standalone gynaecological surgery unit, Mother Hospitals offers surgery, IVF, embryology, and post-operative fertility management under one roof. You do not need to be referred elsewhere for your IVF after your endometriosis surgery — your care is seamlessly managed by the same team.
We do not apply a "surgery first, always" or "IVF first, always" policy. Dr. Prashanthi evaluates each patient's age, reserve, stage, pain score, and fertility goals individually and gives you an honest, evidence-based recommendation — including the option to proceed to IVF without surgery where that is the better choice for you.
Surgery provides significant and lasting pain relief for most women with endometriosis — particularly laparoscopic excision, which is the most effective surgical approach. Studies report 60–80% of patients experience meaningful improvement in dysmenorrhoea (menstrual pain) and pelvic pain after surgery. However, endometriosis is a chronic condition and recurrence is possible — approximately 20–30% of women develop recurrent disease within 5 years, and symptoms may return. Post-operative hormonal suppression (Dienogest or combined pill) significantly delays recurrence. Surgery is the best available treatment for pain that has not responded to hormonal therapy.
For endometriomas larger than 4 cm, cystectomy before IVF is recommended by ESHRE guidelines as it improves egg access and reduces the risk of accidental cyst puncture during egg retrieval. For smaller endometriomas, the evidence is less clear — surgery may reduce ovarian reserve without significantly improving IVF outcomes, and many specialists prefer to proceed directly to IVF. Deep infiltrating endometriosis surgery can improve the uterine implantation environment. Dr. Prashanthi will advise the optimal sequence for your specific situation.
Without post-operative hormonal suppression, recurrence rates are approximately 20–30% at 5 years and 40–50% at 10 years. With hormonal suppression (Dienogest or combined pill), recurrence is significantly delayed. The type of surgery also matters — excision has a lower recurrence rate than ablation because it removes implants more completely. Pregnancy after surgery also significantly reduces recurrence risk due to oestrogenic suppression. Regular follow-up ultrasound scans detect early recurrence before it becomes symptomatic or requires repeat surgery.
Currently, diagnostic laparoscopy with biopsy remains the gold standard for confirming endometriosis. Ultrasound and MRI can detect endometriomas and deep infiltrating endometriosis with good accuracy, but superficial peritoneal implants are invisible on imaging. A negative ultrasound or MRI does not rule out endometriosis. Increasingly, a clinical diagnosis is accepted in women with classic symptoms and ultrasound-confirmed endometriomas, allowing hormonal treatment to begin without mandatory surgery. However, for definitive confirmation — particularly before making major fertility decisions — laparoscopy provides the most accurate information.
Yes — natural conception is possible after endometriosis surgery, and for many women, surgery significantly improves natural pregnancy rates by restoring normal pelvic anatomy and removing barriers to conception. The landmark Marcoux et al. study showed a 30.7% cumulative pregnancy rate at 36 weeks in surgically treated women versus 17.7% in controls. At Mother Hospitals, we encourage a 3–6 month natural conception window after surgery (if tubes are patent, sperm is normal, and age allows) before proceeding to IVF. Age at surgery is an important factor — women over 36 may be advised to proceed to IVF sooner.
Endometrioma cystectomy carries a known risk of reducing ovarian reserve — studies consistently show that AMH decreases by approximately 30% after cystectomy on one ovary, and more significantly after bilateral cystectomy. This is because the cyst wall is closely adherent to normal ovarian cortex, and even careful surgery removes some healthy follicle-bearing tissue along with the cyst. This is why the decision to operate on endometriomas must be carefully individualised, particularly for women with already-low AMH. Dr. Prashanthi checks AMH before surgery and at 3 months post-operatively to monitor reserve.
There is no absolute limit on the number of endometriosis surgeries, but each repeat procedure carries greater risk — of reduced ovarian reserve, adhesion formation, and surgical complications. After a first or second surgery, the risk-benefit balance often shifts in favour of medical management or IVF rather than further surgery. ESHRE guidelines recommend that the decision to perform repeat surgery for endometriomas should account for the woman's ovarian reserve, age, and whether IVF is the preferred route to pregnancy. Dr. Prashanthi will discuss the realistic risks of repeat surgery honestly at your consultation.
Yes — laparoscopic endometriosis surgery at Mother Hospitals is performed under general anaesthesia. This is because the surgery requires the abdomen to be insufflated (inflated) with CO2 gas, and instruments are passed into the abdominal cavity — this requires complete muscle relaxation and patient stillness that only general anaesthesia provides. The surgery takes 45–90 minutes on average. You will be assessed by an anaesthetist pre-operatively and will wake in the recovery room immediately after the procedure. The anaesthesia type is the same as used for any laparoscopic gynaecological procedure.
Dr. E. Prashanthi Reddy · TGMC Reg: 50624