From the Guidelines
Endometriosis can significantly impact fertility, with approximately one-half of patients with endometriosis experiencing infertility. The condition causes fertility issues through several mechanisms, including inflammation that can damage eggs and sperm, scarring and adhesions that distort pelvic anatomy, impaired ovarian function, reduced egg quality, and interference with embryo implantation 1. The severity of fertility impact often correlates with the stage of endometriosis, with more advanced disease typically causing greater fertility challenges.
Key Points to Consider
- Endometriosis is a common condition affecting approximately 10% of individuals assigned female at birth, and it is associated with significant morbidity and economic burden 1.
- The diagnosis of endometriosis is challenging due to variable presenting symptoms and nonspecific physical examination findings, but imaging studies such as expanded protocol transvaginal ultrasound (TVUS) and MRI can help inform patient decision making and surgical planning 1.
- Treatment options for endometriosis-related infertility include surgical removal of endometriosis lesions, fertility medications, and assisted reproductive technologies such as intrauterine insemination (IUI) or in vitro fertilization (IVF) 1.
- Early diagnosis and treatment of endometriosis are crucial for preserving fertility potential, and women experiencing painful periods, chronic pelvic pain, or difficulty conceiving should discuss these symptoms with their healthcare provider.
Recommendations for Clinical Practice
- Clinicians should consider endometriosis as a potential cause of infertility in women experiencing difficulty conceiving, particularly those with a history of pelvic pain or surgery.
- Imaging studies such as TVUS and MRI can be useful in characterizing endometriosis and informing treatment decisions.
- A multidisciplinary approach to diagnosis and treatment, including collaboration between obstetricians, gynecologists, radiologists, and fertility specialists, is essential for optimizing outcomes in women with endometriosis-related infertility.
From the Research
Impact of Endometriosis on Fertility
- Endometriosis has detrimental effects on fertility, including negative impacts on oocyte, tubal, and endometrial function 2.
- The condition's effect on fertility is multifactorial, involving increased inflammation that causes alterations in ovarian, tubal, and uterine function 2.
- Surgical treatment of endometriosis, including laparoscopic surgery, can improve spontaneous pregnancy rates and assisted reproductive technology (ART) pregnancy rates 2, 3.
Treatment Options for Endometriosis-Associated Infertility
- Current treatment options for endometriosis-associated infertility include surgery, superovulation with intrauterine insemination, and in vitro fertilization (IVF) 4, 5.
- Medical or hormonal treatment alone has little or no effect and should only be used in conjunction with ART 5.
- IVF is an effective treatment option in less-advanced disease stages, with success rates similar to those in other causes of infertility 5, 6.
Effect of Endometriosis Stage on Fertility
- The stage of endometriosis, according to the American Fertility Society (AFS) classification, can impact cumulative pregnancy rates in IVF programs 6.
- Women with more advanced stages of endometriosis (stage 3/4) have lower success rates with IVF 5, 6.
- Surgical resection of deep infiltrating endometriosis (stage 3/4) may be recommended before admission to an IVF program, although this is still a topic of debate 6.