[Fertility and deep infiltrating endometriosis]

Area of Science:

• Reproductive Medicine
• Gynecological Surgery

Background:

• Deep infiltrating endometriosis (DIE) is the most severe form, characterized by peritoneal infiltration exceeding 5mm.
• DIE affects multiple pelvic organs, including the bladder, rectovaginal septum, and colon-rectum, often leading to infertility.
• Management of DIE-associated infertility presents complex choices between surgical intervention and assisted reproductive technologies.

Purpose of the Study:

• To review the current understanding of deep infiltrating endometriosis and its impact on fertility.
• To evaluate the efficacy and risks of surgical and in-vitro fertilization (IVF) approaches for managing infertility in DIE patients.
• To provide evidence-based information for patients considering treatment options.

Main Methods:

• Literature review of studies on deep infiltrating endometriosis and infertility management.
• Analysis of pregnancy outcomes following surgical interventions for DIE.
• Assessment of IVF success rates and safety in patients with DIE.

Main Results:

• Surgery for DIE, particularly for pain management, can lead to good pregnancy rates, both spontaneous and post-assisted reproductive technologies.
• Outcomes are less favorable when the digestive tract is involved in DIE.
• In-vitro fertilization (IVF) demonstrates satisfactory results for DIE patients and does not appear to aggravate the condition.

Conclusions:

• There is no definitive evidence favoring IVF or surgery as the primary management for DIE-related infertility.
• Patients must be counseled on the potential benefits of surgery for spontaneous fertility, alongside the risk of severe complications.
• IVF is a viable and safe option for achieving pregnancy in women with deep infiltrating endometriosis.