Assisted reproduction in endometriosis

Area of Science:

• Reproductive Medicine
• Gynecology

Background:

• Endometriosis affects nearly 50% of infertile women, causing pain and infertility.
• Medical treatments manage endometriosis pain and recurrence but do not address infertility.
• Current infertility treatment options for endometriosis include surgery and assisted reproductive technology (ART).

Purpose of the Study:

• To evaluate the role of surgery and ART in managing infertility associated with endometriosis.
• To determine the optimal ART strategy for women with endometriosis.

Main Methods:

• Review of current treatment paradigms for endometriosis-related infertility.
• Analysis of surgical outcomes on natural conception rates.
• Assessment of ART outcomes in women with endometriosis, considering pre-ART surgical impact and ART protocols.

Main Results:

• Surgery can enhance natural conception chances within 12-18 months post-excision, irrespective of endometriosis stage.
• Surgery does not improve ART outcomes and may negatively impact ovarian response.
• ART is often the primary consideration for infertile women with endometriosis, especially those with compromised ovarian reserve or over 35 years old.

Conclusions:

• For infertile women with endometriosis, particularly those over 35 or with diminished ovarian reserve, ART is frequently the primary treatment.
• A segmented ART approach, including agonist trigger, embryo freezing, and deferred transfer, is suggested for optimal outcomes.