Endometriosis related-infertility: does surgery improve IVF outcome? a single center observational- retrospective analysis

Endometriosis is a disease known to be detrimental to fertility. The exact pathophysiology of endometriosis related-infertility is still a source of debate, but it can be detrimental to fertility directly by distorting tubo-ovarian anatomy or indirectly by invoking inflammatory and oxidative damage on the oocytes resulting in poorer quality oocytes. Indeed, toxic content from an endometrioma may lead to unfavourable events such as increased oxidative stress, increase fibrosis, loss of cortex specific stroma, smooth muscle cell metaplasia, vascularization defect and, later, reduced follicular maturation. Women with endometriosis, often require artificial reproductive techniques (ART) to achieve a pregnancy and they represent a dilemma when choosing the appropriate therapy: surgery or IVF. Benefits and risks of these two options should be considered and discussed before planning treatment. The specific impact of endometriosis and the impact of surgical intervention for endometriosis, on the reproductive outcome of women undergoing IVF/ICSI are areas that require further clarification. The risks of surgery and its potential damage to ovarian reserve have to be balanced with the complications associated with the persistence of the endometriosis during ART. The objectives of the present study are follows: (i)to determine the impact of endometrioma on IVF/ICSI outcomes, (ii)to determine the impact of surgery for endometrioma on IVF/ICSI outcome (iii) to determine the impact of deep infiltrating endometriosis (DIE) on IVF/ICSI outcomes, (iv)to determine the impact of surgery for DIE on IVF/ICSI outcome.