Prise en charge de l’infertilité en première intention hors FIV : performances du traitement médical ? Performances de la stimulation ovarienne ? Performances des inséminations ? RPC Endométriose CNGOF-HAS

Boujenah J, J. Boujenah, Santulli P, Piétro Santulli, P Santulli, Mathieu-d'Argent E, E Mathieu-d'Argent, Emmanuelle Mathieu-D’Argent, C Decanter, Christine Decanter, Decanter C, Chauffour C, C Chauffour, Pascal Poncelet, Poncelet P, P Poncelet
Gynecologie, obstetrique, fertilite & senologie · 2018 · vol. 46(3) , pp. 331–337 · doi:10.1016/j.gofs.2018.02.021 · PMID:29551300 · W2789627586
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This paper reviews medical treatments, ovarian stimulation, and insemination for first-line infertility management outside of IVF, as per CNGOF-HAS Endometriosis guidelines.

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Abstract

IntroductionUsing the structured methodology of French guidelines (HAS-CNGOF), the aim of this chapter was to formulate good practice points (GPP), in relation to optimal non-ART management of endometriosis related to infertility, based on the best available evidence in the literature.Materials and methodsThis guideline was produced by a group of experts in the field including a thorough systematic search of the literature (from January 1980 to March 2017). Were included only women with endometriosis related to infertility. For each recommendation, a grade (A-D, where A is the highest quality) was assigned based on the strength of the supporting evidence.ResultsManagement of endometriosis related to infertility should be multidisciplinary and take account into the pain, the global evaluation of infertile couple and the different phenotypes of endometriotic lesions (good practice point). Hormonal treatment for suppression of ovarian function should not prescribe to improve fertility (grade A). After laproscopy for endometriosis related to infertility, the Endometriosis Fertility Index should be used to counsel patients regarding duration of conventional treatments before undergoing ART (grade C). After laparoscopy surgery for infertile women with AFS/ASRM stage I/II endometriosis or superficial peritoneal endometriosis, controlled ovarian stimulation with or without intrauterine insemination could be used to enhance non-ART pregnancy rate (grade C). Gonadotrophins should be the first line therapy for the stimulation (grade B). The number of cycles before referring ART should not exceed up to 6 cycles (good practice point). No recommendation can be performed for non-ART management of deep infiltrating endometriosis or endometrioma, as suitable evidence is lacking.Discussion and conclusionNon-ART management is a possible option for the management of endometriosis related to infertility. Endometriosis Fertilty Index could be a useful tool for subsequent postoperative fertility management. Controlled ovarian stimulation can be proposed.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Infertility, Female Reproductive Techniques, Assisted Endometriosis Endometriosis Female Hormone Antagonists Hormone Antagonists Humans Infertility, Female Infertility, Female Laparoscopy

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