Fertility preservation counselling for women with endometriosis: a European online survey

Abstract

Background: Endometriosis is a common cause for infertility. Decreased ovarian reserve due to pathology or surgical management can reduce the chances of natural pregnancy and limit the effectiveness of controlled ovarian stimulation during fertility treatment. Cryopreservation of oocytes or ovarian cortex prior to surgery or before loss of follicular capital are strategies to preserve fecundity.Methods: An online survey was sent to reproductive specialists and gynaecological surgeons representing major centers of reproductive medicine in Europe to investigate current fertility preservation practices for endometriosis patients.Results: Of 58 responses, 45 (77.6%) in 11/13 countries reported the existence of endometriosis management guidelines, of which 37/45 (82.2%) included treatment recommendations for infertile patients. Most centers (51.7%) reserved fertility counselling for severe endometriosis (large endometriomas with or without deep endometriosis) while 15.5% of centers did not offer fertility preservation for endometriosis.Conclusions: To address non-uniformity in available guidelines and the diversity in fertility preservation practices, we propose an algorithm for managing patients with severe endometriosis most likely to be impacted by reduced ovarian reserve. Improved awareness about the possibilities of fertility preservation and clear communication between gynaecological surgeons and reproductive medicine specialists is mandatory to address the unmet clinical need of preventing infertility in women with endometriosis.

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“…Nonetheless, despite the available guidelines, counselling by reproductive medicine specialists and surgeons is not always consistent. In an online European survey, although 77.6% specialists reported awareness of the existence of endometriosis management guidelines, with 82.2% of them including treatment recommendations for infertile patients, the majority of centres (51.7%) reserved fertility counselling only for severe endometriosis while 15.5% of centres did not offer fertility preservation for endometriosis (Sänger et al, 2023).…”

Fertility preservation in patients with endometriosis: Realistic approach or Future fantasy?

“…64 A recent European survey explores the lack of consensus in the guidelines of fertility preservation in patients presenting with endometriosis, although more than half of the enrolled fertility units (58 fertility units in 13 countries) reserved fertility preservation in cases of large endometriomas with or without deep endometriosis as daily practice. 65 Adolescent endometriosis. It is well known that endometriosis can also occur during adolescence.…”