Endometriosis and Infertility – a consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence)

Juliette Koch; Katrina Rowan; Luk Rombauts; Anusch Yazdani; Michael Chapman; Neil Johnson

doi:10.1111/j.1479-828x.2012.01480.x

Endometriosis and Infertility – a consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence)

Juliette Koch, Katrina Rowan, Luk Rombauts, Anusch Yazdani, Michael Chapman, Neil Johnson

The Australian & New Zealand journal of obstetrics & gynaecology · 2012 · vol. 52(6) , pp. 513–522 · doi:10.1111/j.1479-828x.2012.01480.x · PMID:23016798 · W2026171551

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This consensus statement synthesizes expert opinions on managing endometriosis in infertile women, concluding that surgery and assisted reproduction improve pregnancy rates, while medical treatments have limited roles.

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Abstract

Endometriosis is common in women with infertility but its management is controversial and varied. This article summarises the consensus developed by a group of Australasian subspecialists in reproductive endocrinology and infertility (the Australasian CREI Consensus Expert Panel on Trial evidence group) on the evidence concerning the management of endometriosis in infertility. Endometriosis impairs fertility by causing a local inflammatory state, inducing progesterone resistance, impairing oocyte release and reducing sperm and embryo transport. Medical treatments have a limited role, whereas surgical and assisted reproductive treatments improve pregnancy rates. The role of surgery for deep infiltrative endometriosis and repeat surgery requires further evaluation and there is insufficient evidence for the use of anti-adhesives to improve fertility. Intrauterine insemination (IUI) and in vitro fertilisation (IVF) improve pregnancy rates but women with endometriosis have lower pregnancy rates than those with other causes of infertility. The decision about whether to operate or pursue assisted reproduction will depend on a variety of factors such as the patient's symptoms, the presence of complex masses on ultrasound, ovarian reserve and ovarian access for IVF, risk of surgery and cost. Some women with infertility and endometriosis may benefit from a combination of assisted reproduction and surgery.

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Condition tags

mesh:D004715endometriosisinfertility

MeSH descriptors

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

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