Endometriosis and subfertility: is the relationship resolved?

Area of Science:

• Reproductive Medicine
• Gynecology
• Infertility Research

Background:

• Subfertility affects numerous women globally.
• Endometriosis is a common gynecological condition often associated with infertility.
• The causal link between endometriosis and subfertility requires further elucidation.

Purpose of the Study:

• To review the evidence supporting a causal relationship between endometriosis and subfertility.
• To analyze the impact of endometriosis on fertility outcomes across various stages and treatments.

Main Methods:

• Review of existing literature and observational data.
• Analysis of monthly fecundity rates (MFR) in animal models and human studies.
• Examination of pregnancy rates following different fertility treatments (donor insemination, husband insemination, IVF) in women with and without endometriosis.
• Correlation analysis between endometriosis staging (r-AFS) and fertility metrics.

Main Results:

• Increased prevalence of endometriosis in subfertile populations.
• Reduced MFR in baboons and humans with endometriosis.
• Negative correlation between endometriosis severity (r-AFS stage) and MFR/pregnancy rates.
• Lower implantation and pregnancy rates in women with endometriosis undergoing assisted reproductive technologies (ART).
• Improved MFR and pregnancy rates after surgical intervention for minimal to mild endometriosis.

Conclusions:

• Evidence strongly supports a causal relationship between endometriosis and subfertility.
• Endometriosis negatively impacts fertility through various mechanisms, including reduced fecundity and implantation.
• Surgical treatment of endometriosis can improve fertility outcomes.