Endometriosis-associated infertility

Abstract

This review summarizes the recent literature examining the relationship between endometriosis and infertility. It is clear that the advanced stage of the disease and the mechanical disruption of the pelvic anatomy may cause infertility. The link between early stage endometriosis and infertility remains a source of controversy. Management plans must be individualized contingent upon the stage of disease, the age of the patient and the duration of infertility. The preponderance of data suggests that ablative therapy at the time of laparoscopy is as good as, or superior to expectant or medical therapy. With the exception of IVF/ET, ovarian suppression with GnRH agonists is not warranted in endometriosis-associated infertility. Controlled ovarian hyperstimulation with IUI is appropriate therapy in women with minimal-to-mild and surgically corrected endometriosis.

Controlled ovarian hyperstimulation and intrauterine insemination for infertility associated with endometriosis: a retrospective analysis

“…Several investigations have generated support for the association between endometriosis and infertility, but a specific cause and effect relationship yet is not established. Traditionally, endometriosis-associated infertility has been attributed to primarily advanced stages of pelvic disease, which cause lesions including tubal and ovarian adhesions that may, through mechanical means, impair normal reproductive processes [3]. Panidis et al [12] reviewed the putative mechanisms of early-stage endometriosis in the etiology of subfertility.…”

L-carnitine supplementation reduces oocyte cytoskeleton damage and embryo apoptosis induced by incubation in peritoneal fluid from patients with endometriosis

“…Surgically induced endometriosis in rats results in decreased fecundity (3), and intraperitoneal injections of peritoneal fluid (PF) from women with endometriosis into mice lowers the implantation rate (4). Moderate or severe endometriosis causes infertility due to mechanical disruption of ovulation or efficient gamete transport (5). Even in its mildest forms, endometriosis may contribute to infertility (6).…”

Advances in Treatment Options of Endometriosis

“…Controlled Ovarian Hyperstimulation (COH) with or without Intrauterine Insemination (IUI) RCTs evaluating the efficacy of ovulation induction with or without IUI have demonstrated that ovulation induction increases conception rates in endometriosisassociated infertility with no disrupted pelvic anatomy or male factor infertility [1,50,[67][68][69][70] ( table 4 ). Guzick et al [71] compared fecundity rates after randomizing their patients into intracervical insemination (ICI), intrauterine insemination (IUI), gonadotropin induction/ICI, and gonadotropin induction/IUI.…”

“…retrieval and inferior laboratory methodologies used in early studies may explain this inconsistency [67] . Enhanced conception rates with increasing disease stage have also been noted [77] .…”