From Endometriosis to Pregnancy: Which is the “Road-Map”?

Abstract

with severe endometriosis is associated with significantly lower pregnancy rates when compared with women without endometriomas (5). The negative impact of surgical excision of an endometrioma on ovarian reserve and on anti-Müllerian hormone (AMH) levels has been demonstrated (6). Despite the fact that surgery for deep infiltrating endometriosis (DIE) may increase spontaneous conception (7), recent guidelines do not recommend surgery with the single aim of improving assisted reproductive technology (ART) outcomes (6). Several studies have taken into consideration how endometriosis affects pregnancy achievement and pregnancy development, including obstetric complications (8). Pregnancy complications accompanying preexisting endometriosis may be explained by some pathogenic mechanisms, such as endometriosis-related chronic inflammation (9), the presence of adhesions and their mechanical implications (10), and the invasion of decidualized ectopic endometrium in to the vessels wall (11, 12). The aim of this review is to analyze the current literature regarding the relationship between different forms of endometriosis (endometrioma, peritoneal endometriosis, DIE) and infertility, and the impact of endometriosis on pregnancy outcomes. Does endometrioma mean infertility? Endometrioma is a frequently encountered entity in ovarian surgery and affects from 17% to 44% of patients with endometriosis (13). The most common symptoms of ovarian endometriomas include dysmenorrhea, chronic pelvic pain, dyspareunia, and infertility. Transvaginal ultrasound (TVU) has a high diagnostic accuracy for the diagnosis of endometrioma

<p>Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment</p>

“…Furthermore, studies conducted have various limitations: the majority of them are retrospective; analyze non-homogeneous groups, with different extension of lesions, presence of concurrent diseases affecting fertility and lastly different surgical and medical strategies. 92 Harb et al showed a significant reduction in pregnancy rates and implantation rates in women with severe endometriosis (Stage III/IV) who underwent assisted reproductive technology (ART) treatment. 93 There is no agreed consensus regarding surgical management of bowel endometriosis in cases of concurrent infertility.…”

Endometrial cyst and its changes during pregnancy – a narrative review of the literature

“…Such complications include miscarriage -OR (odds ratio) = 1.76 (95% CI: 1.44-2.15), ectopic pregnancy -OR = 2.70 (95% CI: 1.09-6.72), pre-eclampsia (OR = 1.18, 95% CI: 1.01-1.39), gestational diabetes (RR (relative risk) = 1.26, 95% CI: 1.03-1.55), gestational cholestasis (OR = 4.87, 95% CI: 1.85-12.83), placenta previa (OR = 3.31, 95% CI: 2.37-4.63), antepartum haemorrhage (OR = 1.69, 95% CI: 1.38-2.07), and antepartum hospital admissions (OR = 3.18, 95% CI: 2.60-3.87). There is also a higher risk of neonatal complications such as preterm premature rupture of membranes (OR = 2.33, 95% CI: 1.39-3.90), stillbirth (OR = 1.29, 95% CI: 1.10-1.52), preterm birth (OR = 1.70, 95% CI: 1.40-2.06), small for gestational age (< 10 percentile) (OR = 1.28, 95% CI: 1.11-1.49), and admission to a neonatal intensive care unit (OR = 1.39, 95% CI: 1.08-1.78) [7][8][9][10][11]. The literature also presents cases of surgical complications of visceral endometriosis such as intestinal perforation, appendicitis, rapture of endometriomas and fallopian tubes, or spontaneous pneumothorax [6].…”