{"paper_id":"0a9396bb-0a30-497f-a740-7f8eacb60158","body_text":"Abstract\nPurpose\nThis study was undertaken to evaluate the prevalence of endometriosis in infertile women of couples with non-male factor infertility.\nMethods\nA retrospective validation analysis was carried out of consecutive women of infertile couples with non-male factor infertility who received combined diagnostic hysteroscopy and laparoscopy, in the period from January 2017 to August 2019 in the Department for Gynecology and Reproductive Medicine (n = 300). Type, stage and site of endometriosis were assessed and matched with the occurrence of tubal stenosis. Binary regression analysis was used to estimate the prevalence of endometriosis.\nResults\nEndometriosis was diagnosed in 67% (n = 201). Primary infertility (OR 1.76; p = 0.036), dysmenorrhea (OR 2.47; p = 0.002), and a shorter cycle length (OR 0.972; p = 0.036) were independent risk factors for detection of endometriosis in diagnostic hystero-laparoscopy. The most frequent endometriosis sites were pelvic side wall (53.2%) and uterosacral ligaments (41.8%). Patients with endometriosis showed less often a tubal occlusion (34.32% vs. 41.4%; p = 0.205) and presented a lower rate of bilateral obstruction (9.5% vs. 18.8.%, p = 0.024). Women with endometriosis of a Fallopian tube showed a higher rate of tubal occlusion on the same side (right side p = 0.002; left side p = 0.001). Patients with rASRM score III showed the highest rate of tubal obstruction.\nConclusions\nThe prevalence of endometriosis in infertile women was higher than expected. The indication for operative infertility diagnostics by minimal invasive techniques should be made much more generous as well as the complete clarification of the causes of female infertility.\nSimilar content being viewed by others\nReferences\nSoliman AM, Yang H, Du EX, Kelley WC (2016) The direct and indirect costs associated with endometriosis: a systematic literature review. Hum Reprod 31(4):712–722\nBuck Louis GM, Hediger ML, Peterson CM et al (2011) Incidence of endometriosis by study population and diagnostic method: the ENDO Study. Fertil Steril 96(2):360–365\nDunselman GA, Vermeulen N, Becker C et al (2014) ESHRE guideline: management of women with endometriosis. Hum Reprod 29(3):400–412\nUccella S, Marconi N, Casarin J et al (2016) Impact of endometriosis on surgical outcomes and complications of total laparoscopic hysterectomy. Arch Gynecol Obstet 294(4):771–778\nRigharts A, Osborne L, Connor J, Gilett W (2018) The prevalence and potential determinants of dysmenorrhoea and other pelvic pain in women: a prospective study. BJOG 125:1532–1539\nMissmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ (2004) Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol 160:784–796\nCollins JA, Burrows EA, Wilan AR (1995) The prognosis of live birth among untreated infertile couples. Fertil Steril 64(1):22–28\nD’Hooghe TM, Debrock S, Hill JA, Meuleman C (2003) Endometriosis and subfertility: is the realionship resolved? Semin Reprod Med 2182:243–254\nMeuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmermann D, D’Hooghe TM (2009) High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril 92(1):68–74\nAkande VA, Hunt LP, Cahill DJ, Jenkins JM (2004) Differences in time to natural conception between women with unexplained infertility and infertile women with minor endometriosis. Hum Reprod 19(1):96–103\nPractice Committee of the American Society for Reproductive Medicine (2012) Endometriosis and infertility: a committee opinion. Fertil Steril 98(3):591–598\nTomassetti C, D’Hooghe T (2018) Endometriosis and infertility: insights into the causal link and management strategies. Best Pract Res Clin Obstet Gynaecol 51:25–33\nHarb HM, Gallos ID, Chu J, Harb M, Coomarasamy A (2013) The effect of endometriosis on in vitro fertilisation outcome: a systematic review and meta-analysis. BJOG 120(11):1308–1320\nDuffy JM, Arambage K, Correa FJ et al (2014) Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev 4:CD11031\nTanbo T, Fedorcsak P (2017) Endometriosis-associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta Obstet Gynecol Sacnd 96:659–667\nPrescott J, Farland LV, Tobias DK et al (2016) A prospective cohort study of endometriosis and subsequent risk of infertility. Hum Reprod 31:1475–1482\nRomanski PA, Brady PC, Farland LV, Thomas AM, Hornstein MD (2019) The effect of endometriosis in the antimüllerian hormone level in infertile population. J Assist Reprod Genet 36(6):179–1184\nGiudice LC (2010) Clinical practice: endometriosis. N Engl J Med 362(25):2389–2398\nBallard KD, Seaman HE, deVries CS, Wright JT (2008) Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study-part 1. BJOG 115(11):382–391\nAudebert A, Petousis S, Margioula-Siarkou C, Ravanos K, Prapas N, Prapas Y (2018) Anatomic distribution of endometriosis: a reappraisal based on series of 1101 patients. Eur J Obstet Gynecol Reprod Biol 230:36–40\nApprobato FC, Approbato MS, Rezende DF, Silva TM, Lima YAR, Benetti BBDC (2019) Endometriosis III and IV as a risk factor for tubal obstruction in infertile women. JBRA Assist Reprod. https://doi.org/10.5935/1518-0557.20190004\nYounis JS, Shapso N, Fleming R, Ben-Shlomo I, Izhaki I (2019) Impact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve: a systematic review and meta-analysis. Hum Reprod Update 25(3):375–391\nAcknowledgements\nThe authors would like to thank Dr Thomas Lehmann, Institute of Medical Statistics, Informatics and Documentation, University Hospital, Friedrich-Schiller-University Jena, Germany, for assistance in project development.\nAuthor information\nAuthors and Affiliations\nContributions\nKN: protocol/project development, data collection and data management and manuscript writing/editing. DB: data collection. RS: data collection. KB: project development. HD: project development. IBR: manuscript writing/editing.\nCorresponding author\nEthics declarations\nConflicts of interest\nThe authors have no conflicts of interest to declare.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nAbout this article\nCite this article\nNicolaus, K., Bräuer, D., Sczesny, R. et al. A two-third majority of infertile women exhibit endometriosis in pre-ART diagnostic hysteroscopy and laparoscopic chromopertubation: only one-third have a tubal obstruction. Arch Gynecol Obstet 301, 1081–1088 (2020). https://doi.org/10.1007/s00404-020-05479-5\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-020-05479-5","source_license":"CC0","license_restricted":false}