O-058 The impact of endometriosis on fertility treatment

Abstract Abstract text Endometriosis can affect natural fertility by distorting pelvic anatomy and by causing local pelvic inflammation that affects the quality of the oocytes, the function of the tubes and the sperm capacity to fertilize. Two approaches can be foreseen, either removing the disease with the aim of restoring normality (surgery) or overcoming the disease by retrieving oocytes in the ovary and allowing their fertilization in in vitro conditions (IVF). Both therapeutic approaches seem rational and wise. However, despite this apparently simple clinical scenario, management of endometriosis-related infertility has engendered long-lasting and burning debates over the last two decades and, to date, no consensus has been reached. Robust scientific evidence is scant, actually limited to the demonstration that laparoscopy modestly increases the chance of natural conception. In this debate, it is noteworthy that chances of pregnancy do not represent the unique stake. Other factors can play a role and deserves consideration. Considering the choice of fertility treatment, he most relevant are the following: 1) the impact of ovarian endometriomas and their removal on ovarian responsiveness, 2) the impact of endometriomas and endometriosis in general on oocytes quality, 3) the additional risks of oocytes retrieval in the presence of endometriosis (infections in particular) 4) the detrimental effects of endometriosis-related hydrosalpinx, 5) the impact of endometriosis on uterine motility and endometrial receptivity, 5) the confounding effect of endometriosis-associated adenomyosis. Unfortunately, for the vast majority of these concerns, evidence is not definite and physicians have to take decisions based on their clinical commonsense.