Endometriosis and fertility preservation: the importance of personalised approach in decision making

Graduating from medical school with a high ranking requires regular and hard work. Istanbul

University is one of the oldest and most established medical schools in Türkiye. My education

there gave me a strong working discipline and the habit of reading and studying regularly.

After graduation, I decided to specialise in obstetrics and gynaecology. At that time, I had not

yet decided to focus on reproductive endocrinology. However, my interest in obstetrics and

gynaecology during medical school later shaped my career in this direction.

My training at Yale was an important turning point in my career. During that period, I focused

mainly on reproductive endocrinology and endometriosis. Working with two internationally

well-known mentors improved both my clinical and scientific knowledge.

When I returned to Türkiye, I decided to continue my work in reproductive endocrinology.

I also wanted to study endometriosis in both clinical practice and scientific research.

The department at Yale was very strong in this field. I also had the opportunity to attend scientific

meetings in the United States and visit different centres. These experiences broadened my

knowledge and perspective. I was also impressed by the research being conducted at the NIH

at that time. In the early 2000s, seeing that endometriosis was already receiving such

scientific attention was very important and encouraging for me.

Endometriosis, infertility, IVF, and reproductive surgery are closely related. A significant

proportion of patients with endometriosis also have infertility. Some of these patients may

also need reproductive surgery.

For this reason, it is not enough to assess the patient only from the perspective of IVF,

endometriosis, or surgery. Training and experience in all these areas allow you to evaluate the

patient as a whole. This helps you choose the most suitable treatment and manage the patient

together with an experienced IVF team when necessary.

The main factors are the patient’s age, current ovarian reserve, main complaint, previous

surgeries, and medical history. It is also important to determine whether pain or infertility is

the main problem. Decision-making is particularly difficult in older patients, patients with

diminished ovarian reserve, and those with advanced endometriosis.

Therefore, the approach should be individualised for each patient. We need to decide whether

to preserve fertility first by freezing oocytes, perform surgery, or proceed directly to IVF. The

patient’s age, ovarian reserve, symptoms, and history of endometriosis surgery should all be

considered together before making this decision.

I can say with pride that we founded the Endometriosis and Adenomyosis Society in 2009,

when endometriosis was still not widely known in Türkiye. I led this process together with

my colleagues and served as the founding president for many years. I am currently serving as

president again.

In 2016, I was elected to the board of the European Endometriosis League, and I later had the

opportunity to serve as its president for two years. These positions helped us increase

awareness of endometriosis in Türkiye and neighbouring countries. Through the meetings,

educational activities, and patient-related work of our Society, endometriosis has become

better recognised in the region.

The European Endometriosis League and the Endometriosis and Adenomyosis Society of

Türkiye still work in close collaboration. Several of our colleagues have also taken part in the

League’s young groups and board.

About two years ago, I was appointed as an affiliated professor at Umeå University in Sweden

based on our scientific work. This position gave me a different academic perspective.

Northern European countries are very strong in scientific research in this field.

My collaboration with Umeå University has also expanded my international academic

network. We are still working on joint projects. I believe these collaborations contribute to my

academic work, our Society, and the scientific position of our country.

About three-quarters of my publications are related to endometriosis, and some of them also

focus on reproduction and infertility. One of the main points from our work is that patients

with endometriosis need a more careful and individualised approach during IVF treatment.

Many of these patients have diminished ovarian reserve, and other conditions may also be

present. Therefore, they should be evaluated carefully. If the patient is assessed correctly and

managed by an experienced IVF team, satisfactory results can be achieved.

In the next ten years, I expect important developments in the medical treatment of

endometriosis and in methods for preserving ovarian reserve. I believe these developments

will be particularly important for patients with endometriosis.

Awareness of fertility preservation, especially oocyte freezing, will also increase among both

doctors and patients. As a result, these procedures will probably be used more often and at a

more appropriate time. My main expectation for the next decade is to have better treatment

options for endometriosis and more effective ways to preserve ovarian reserve.