standard ultrasounds often miss early endometriosis. Many women wait 7-10 years for a diagnosis. — EndoSure Edmonton | Dr. Sam Azer

Endometriosis & Your Fertility

Struggling to Conceive? The Silent Link Between Endometriosis and Infertility

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"For many women, the first sign of endometriosis isn't pain—it’s difficulty getting pregnant. It is estimated that up to 50% of women with infertility have endometriosis, often without knowing it.1
At The Links Clinic in Edmonton, Dr. Sam Azer understands the emotional toll of infertility. Endometriosis can affect fertility by causing inflammation that damages sperm or eggs, or by creating scar tissue (adhesions) that blocks the fallopian tubes. However, a diagnosis does not mean you cannot become a parent.2 Identifying and treating endometriosis early is one of the most effective ways to restore or preserve your fertility."3

How We Help You Move Forward:

Early, Non-Invasive Answers: We use EndoSure to screen for endometriosis without surgery. This helps us identify if "silent endometriosis" is the root cause of your fertility challenges.
Fertility-Sparing Treatment: Dr. Azer specializes in management plans focused on preserving your reproductive health, whether through medical management or targeted surgical intervention to remove scar tissue.
A Personalized Plan: We look at the whole picture. By treating the underlying endometriosis, many patients see improved fertility outcomes naturally or have higher success rates with assisted reproductive technologies.

Here is a complete draft for the blog post, written in a tone that balances medical authority with patient empathy. It is optimized for SEO and designed to accompany the first infographic we created.

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Diagnosed with an ovarian endometrioma? Discover why cyst size shouldn't be the only factor in choosing surgery. Dr. Sam Azer explains the modern, fertility-sparing approach at The Links Clinic in Edmonton.

You’ve just received your ultrasound report.

Maybe you are reading the words "ovarian endometrioma" or "chocolate cyst" for the first time. Perhaps you are fixated on the numbers: 4 cm, 5 cm, 6 cm.

For years, the standard medical advice was simple: if a cyst was larger than 3 or 4 centimeters, we removed it. But in the world of modern endometriosis care, that "rule of thumb" is changing.

At The Links Clinic, we follow the latest international guidelines (including ESHRE 2022 and NICE 2024), which tell us that size alone is rarely a good reason for surgery. Here is why we are moving away from the "size myth" and what actually matters when creating your treatment plan.

1. Treat the Patient, Not the Picture

An ultrasound image can tell us how big a cyst is, but it cannot tell us how much pain you are in.

Interestingly, there is often a "disconnect" in endometriosis: some women with large cysts have zero pain, while others with tiny implants suffer daily.

If you have a larger cyst but are asymptomatic (no pain, normal periods), rushing into surgery might not offer you any benefit—and it comes with risks. Modern guidelines suggest that for many asymptomatic women, "watchful waiting" (monitoring with ultrasound) is a safe and effective strategy.

2. The Fertility Factor: Why We Are Conservative

This is the most critical consideration for my patients who hope to conceive now or in the future.

Every time we operate on an ovary to peel away a cyst (a procedure called a cystectomy), there is a risk of removing healthy ovarian tissue along with it. This can lower your AMH levels (Anti-Müllerian Hormone), which is a marker of your egg reserve.

If your goal is pregnancy, especially if you are considering IVF, keeping your ovarian reserve high is often more important than removing a stable cyst. Unless a cyst is so large that it blocks egg retrieval, we often advise against surgery solely to improve fertility.

3. When IS Surgery Necessary?

While we are more conservative than in the past, surgery remains a vital tool for many women. We typically recommend intervention if:

Pain is unmanageable: Medical management (medication) hasn't worked, and the cyst is causing significant pelvic pain.
Suspicion of Malignancy: The ultrasound shows "complex features" that need to be investigated to rule out cancer.
Rapid Growth: The cyst is growing very quickly between appointments.
Infertility Barriers: The cyst is physically obstructing fertility treatments (like egg retrieval).

The Bottom Line

There is no "magic number" for surgery. A 3 cm cyst in a woman with severe pain might need surgery, while a 5 cm cyst in a woman with no symptoms might be safely observed.

Your treatment should be as unique as you are. It should be based on your pain levels, your desire for children, and your ovarian reserve—not just a number on a page.

Need a Second Opinion?

If you have been told you need surgery solely based on the size of a cyst, let’s discuss your options.

Contact Dr. Sam Azer at The Links Clinic