Endometriosis and Subfertility: Is the Relationship Resolved?

Thomas D'Hooghe, Thomas D’Hooghe, Thomas M D'Hooghe, Sophie Debrock, Joseph A Hill, Christel Meuleman
Seminars in reproductive medicine · 2003 · vol. 21(2) , pp. 243–254 · doi:10.1055/s-2003-41330 · PMID:12917793 · W2339993699
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review analyzes evidence including epidemiological data, animal models, and clinical outcomes suggesting a causal link between endometriosis, particularly advanced stages, and reduced fertility rates.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This article reviews evidence supporting a causal relationship between endometriosis and subfertility, drawing on studies comparing endometriosis prevalence and reproductive outcomes between subfertile and proven-fertile women, including primate fecundity experiments, correlations of endometriosis stage with monthly fecundity and pregnancy rates, and findings across assisted reproduction settings (donor and husband insemination, IVF implantation rates). Across these lines of evidence, the review reports trends such that more advanced endometriosis severity is associated with lower monthly fecundity and pregnancy/implantation metrics, while surgical removal of minimal–mild disease is associated with improved fecundity measures. A key caveat is that the evidence base spans heterogeneous study designs and models, and the review itself does not provide new primary experimental data. This paper is centrally about endometriosis — it specifically synthesizes arguments and findings linking endometriosis severity to reduced fertility and subfertility outcomes.

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Abstract

There are many arguments to support the hypothesis that there is a causal relationship between the presence of endometriosis and subfertility. These arguments are reviewed in this article and include: (1) an increased prevalence of endometriosis in subfertile women compared with women of proven fertility; (2) a reduced monthly fecundity rate (MFR) in baboons with mild to severe (spontaneous or induced) endometriosis compared with those with minimal endometriosis or a normal pelvis; (3) a trend toward a reduced MFR in infertile women with minimal to mild endometriosis compared with women with unexplained infertility; (4) a dose-effect relationship: a negative correlation between the r-AFS stage of endometriosis and the monthly fecundity rate and crude pregnancy rate; (5) a reduced monthly fecundity rate and cumulative pregnancy rate after donor sperm insemination in women with minimal-mild endometriosis compared with those with a normal pelvis; (6) a reduced MFR after husband sperm insemination in women with minimal to mild endometriosis compared with those with a normal pelvis; (7) a reduced implantation rate per embryo after IVF in women with moderate to severe endometriosis compared with women with a normal pelvis; and (8) an increased monthly fecundity rate and cumulative pregnancy rate after surgical removal of minimal to mild endometriosis.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Infertility, Female Animals Endometriosis Endometriosis Endometriosis Endometriosis Female Fertilization in Vitro Humans Infertility, Female Infertility, Female Insemination, Artificial Ovulation Induction Pregnancy Pregnancy Rate Prevalence

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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