Préservation de la fertilité dans l'endométriose : état des lieux des connaissances et des pratiques professionnelles en France

Objective. Assess knowledge and professional practices concerning fertility preservation for endometriosis in France. Design National observational study, descriptive survey type by online self-questionnaire, addressed to french specialists in 2019. Results. We obtained 110 analyzable responses. Our sample was mainly composed of surgeons (54%) and reproductive clinicians (19%), with a good experience (15 years on average). 91% declared that they were aware of the latest recommendations issued by the CNGOF and the HAS in december 2017. The diagnosis seemed clinical and/or histological (70%). The main surgical techniques performed are cystectomy (51%), destruction by plasma energy (29%) and bipolar coagulation (8.5%). 78% systematically or often prescribe a dosage of AMH preoperatively against 37.3% postoperatively. 74% have experience of FP in endometriosis. They offer it in cases of bilateral or recurrent endometriomas but only 33% in case of unilateral endometriomas. This consist of a oocyte vitrification (87%). Discussion and conclusion. We observe in our population of sensitized practitioners (selection bias) a good knowledge of the pathology and recommendations, with information provided to patients. The operating practices are adapted (except for bipolar coagulation). AMH pre- and post-operative dosages seem important to assess the impact of surgery. Indications of high-risk FP are retained, although awareness appears necessary in the case of unilateral endometriomas. The role of multidisciplinary concertation meeting is essential both for the discussion of surgical indications and for FP proposals. The creation of dedicated structures, for example regional, made up of “expert” surgeons and reproductive clinicians, should be encouraged. FP should be carried out optimally, "neither too early nor too late", ideally before the age of 36.