Fertility preservation counselling for women with endometriosis: a European online survey

Background Endometriosis is a common cause for infertility. Decreased ovarian reserve due to pathology or surgical management can reduce the chances of natural pregnancy and limit the effectiveness of controlled ovarian stimulation during fertility treatment. Cryopreservation of oocytes or ovarian cortex prior to surgery or before loss of follicular capital is a strategy to preserve fecundity.

An online survey was sent to reproductive specialists and gynecological surgeons representing major centers of reproductive medicine in Europe to investigate current fertility preservation practices for endometriosis patients.

Of 58 responses, 45 (77.6%) in 11/13 countries reported the existence of endometriosis management guidelines, of which 37/45 (82.2%) included treatment recommendations for infertile patients. Most centers (51.7%) reserved fertility counselling for severe endometriosis (large endometriomas with or without deep endometriosis) while 15.5% of centers did not offer fertility preservation for endometriosis.

To address non-uniformity in available guidelines and the diversity in fertility preservation practices, we propose an algorithm for managing patients with severe endometriosis most likely to be impacted by reduced ovarian reserve. Improved awareness about the possibilities of fertility preservation and clear communication between gynaecological surgeons and reproductive medicine specialists is mandatory to address the unmet clinical need of preventing infertility in women with endometriosis. Similar content being viewed by others Data availability This was not an interventional study and no new patient data were created or analyzed. Data sharing is not applicable to this article. Abbreviations - ACOG: - American college of obstetricians and gynecologists - AFC: - Antral follicular count - AMH: - Anti-müllerian hormone - ART: - Assisted reproductive techniques - ASRM: - American society for reproductive medicine - AWMF: - Arbeitsgemeinschaft der wissenschaftlichen medizinischen fachgesellschaften - CNGOF: - Collège national des gynécologues et obstétricien français - DGGG: - Deutsche gesellschaft für gynäkologie und geburtshilfe - ESHRE: - European society of human reproduction and embryology - FertiPROTEKT: - Network of fertility preservation centres in German-speaking countries - FIGO: - International federation of gynecology and obstetrics - FP: - fertility preservation - FSH: - Follicle-stimulating hormone - GnRH: - Gonadotropin-releasing hormone - IVF: - In vitro fertilization - NICE: - National institute for health and care - SEF: - Sociedad española de fertilidad - SIGO: - Italian society of gynecology and obstetrics - SOGC: - Society of obstetricians and gynaecologists of Canada - WES: - World endometriosis society

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Editorial support and assistance in the preparation of figures was provided by Joanne Fitz-Gerald and Jonathan A C Lee at FourWave Medical Communications, the funding for which was provided by PregLem S.A./Gedeon Richter. Funding The survey platform was funded by PregLem (PregLem SA, Route de Frontenex 41A, 1207 Geneva, Switzerland) [a member of the Gedeon Richter group, Budapest, Hungary] and dispersed through the ORBIS-network across Europe. Author information Authors and Affiliations Contributions NS and JV conceived of the presented idea, developed the survey and performed the computations. NS and MM verified the analytical methods. All authors helped to shape the research, disseminate the survey and contributed to the analysis and interpretation of the results. NS took the lead in writing the manuscript and all authors provided critical feedback and contributed to the final manuscript. All authors have read and agreed to the published version of the manuscript. Corresponding author Ethics declarations Conflict of interest MM is employed by the funder of this survey, PregLem S.A., and contributed to the design of the survey and reviewed the manuscript. The other authors declare no conflicts of interest. Ethical approval Not applicable. Consent to participate Not applicable. Consent for publication Not applicable. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions About this article Cite this article Sänger, N., Menabrito, M., Di Spiezo Sardo, A. et al. Fertility preservation counselling for women with endometriosis: a European online survey. Arch Gynecol Obstet 307, 73–85 (2023). https://doi.org/10.1007/s00404-022-06616-y Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-022-06616-y