Minimal and mild endometriosis negatively impact on pregnancy outcome

Abstract

Endometriosis, a highly prevalent gynecological disease, can lead to infertility in moderate to severe cases. Whether minimal stages are associated with infertility is still unclear. The purpose of this systematic review is to present studies regarding the association between pregnancy rates and the presence of early stages of endometriosis. Studies regarding infertility, minimal (stage I, American Society of Reproductive Medicine [ASRM]) and mild (stage II, ASRM) endometriosis were identified by searching on the MEDLINE database from 1985 to September 2011 using the following MESH terms: endometriosis; infertility; minimal; mild endometriosis; pregnancy rate. 1188 articles published between January of 1985 and November of 2011 were retrieved; based on their titles, 1038 citations were excluded. Finally, after inclusion and exclusion criteria, 16 articles were selected to be part of this systematic review. Several reasons have been discussed in the literature to explain the impact of minimal endometriosis on fertility outcome, such as: ovulatory dysfunction, impaired folliculogenesis, defective implantation, decrease embryo quality, abnormal immunological peritoneal environment, and luteal phase problems. Despite the controversy involving the topic, the largest randomized control trial, published by Marcoux et al. in 1997 found a statistically different pregnancy rate after resection of superficial endometrial lesions. Earlier stages of endometriosis play a critical role in infertility, and most likely negatively impact pregnancy outcomes. Further studies into stage I endometriosis, especially randomized controlled trials, still need to be conducted.

Endometrial Polyps Effect on Pregnancy Outcomes in Infertile Women with Minimal/Mild Endometriosis: A Retrospective Study

“…However, the impact of early-stage endometriosis on infertility remains uncertain as the effect of pelvic adhesion is not so severe. The mechanism to cause infertility in minimal/mild endometriosis may involve in the abnormal immunological environment, ovulatory dysfunction, defective implantation, and eutopic endometrium abnormalities [5,6]. Laparoscopic surgery, which is used as the most common approach for the treatment of minimal/mild endometriosis, can improve these women's natural fertility [7,8].…”

Ethiopathogenic mechanisms of endometriosis-related infertility

“…It affects approximately 25 to 50% of infertile women, and 30 to 50% of endometriosis patients have difficulties to become pregnant (ASRM, 2012). Although the literature widely addresses the association between the disease and infertility (Akande et al ., 2004; Carvalho et al ., 2012; Da Broi & Navarro, 2016b; Gupta et al ., 2008; Marcoux et al ., 1997; Parazzini, 1999), the etiopathogenic mechanisms involved in this relation have not yet been fully understood.…”

Peritoneal Fluid From Infertile Women With Minimal/Mild Endometriosis Compromises the Meiotic Spindle of Metaphase II Bovine Oocytes: A Pilot Study

“…However, in early stages of the disease (minimal and mild endometriosis), this relationship is not apparent, since the pelvic adhesions are not sufficiently severe to cause anatomical alterations. 6 Natural fertility seems to be impaired in women with endometriosis, even during early stages of the disease. [7][8][9] However, to date, the mechanisms responsible for the decrease in fertility in these women have not been completely elucidated.…”