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Why up to 5090% of women with infertility may have underlying endometriosis even when imaging appears normal The difference between symptom suppression and disease removal and why that distinction matters for pregnancy outcomes Why IVF may be considered a bypass therapy rather than root-cause treatment in certain cases How elevated estrogen during IVF stimulation can potentially worsen active endometriosis What optimal excision truly means and why not all endometriosis surgery is equal The surprising impact of adhesions on fertility , and why adhesion prevention protocols matter Why a normal ultrasound does not rule out endometriosis How surface disease (even without severe distortion) can still impact egg quality and implantation Why AMH may be more predictive than FSH when evaluating ovarian reserve before surgery The importance of timing progesterone 7 days after ovulation , not blindly on Day 21 Why a progesterone level under 10 ng/mL may not be optimal for implantation How excision surgery can improve spontaneous pregnancy rates in properly selected patients Why adenomyosis does not automatically eliminate pregnancy potential What questions to ask a surgeon before committing to surgery The data behind repeat surgery rates when excision is performed thoroughly Why fertility and wellness are not separate conversations in womens health This episode does not argue against IVF

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