Fertility preservation in endometriosis: current strategies and outcomes

Endometriosis is a frequent chronic estrogen-dependent condition that can significantly impair fertility and reduce the quality of life in affected individuals. Women with endometriosis face a 30-50% risk of infertility. Multifactorial factors such as peritoneal inflammation, altered ovarian reserve, impaired tubal function and modified endometrial receptivity have been proposed to contribute to infertility. Endometriosis has been highlighted as a condition that may require a fertility preservation to safeguard reproductive potential. This review aims to provide a comprehensive update on fertility preservation for women with endometriosis. A comprehensive literature search was conducted using PubMed, focusing on peer-reviewed studies. Key words included "endometriosis," "fertility preservation," "oocytes," and "cryopreservation." Studies in English and French that delve into FP techniques, success factors, and risks were included. Several fertility preservation techniques are available, but oocyte cryopreservation following ovarian stimulation is the most common and effective option for women affected by endometriosis. Success rates depend on factors such as age and prior surgical history. Surgery for ovarian endometriomas may reduce ovarian reserve, underscoring the importance of considering fertility preservation before surgery. All of ovarian stimulation protocols can be used and may not increase the risk of disease progression or recurrence however the use of an antagonist protocol with GnRH agonist triggering could be particularly beneficial in this context, as it may help reduce pain and minimize the risk of ovarian hyperstimulation syndrome. The number of cryopreserved oocytes is directly correlated with pregnancy success. Multiple stimulation cycles can be performed to obtain a sufficient number of oocytes, increasing the chances of achieving a successful live birth in case of reuse. FP should be routinely discussed with women with endometriosis, particularly those who may undergo surgery, however, its implementation is not systematic and should be considered on a case-by-case basis. Further research is essential to tailor FP strategies for women with endometriosis optimizing both clinical outcomes and cost-effectiveness.