Endometriosis dan Infertilitas

Endometriosis is a gynecological disease that often occurs in at least 10% of women of reproductive age. There are 25-50% infertile women with endometriosis and 30-50% of them are infertile. Mechanism of how endometriosis affects fertility can not be fully explained so that the management of patients with infertility problems is still controversial. The purpose ofwriting this article is to discuss the relationship management of endometriosis with infertility by using of literature study. It can be concluded that the mechanism of infertility because of endometriosis remains unclear, there are several factors that allegedly plays a role in the mechanism of distortion of anatomy, impaired peritoneal function, immunological disorders, endocrine disorders and ovarium as well as disruption of implantation. Endometriosis infertility management is very complex and must consider the aspect of age, duration of infertility, family history of endometriosis, pelvic pain and endometriosis staging. Medical therapy was effective to reduce the complaints of endometriosis but did not increase fecundity and fertility, whereas the laparoscopic surgical therapy significantly increased pregnancy rate and live birth rate. The combination of medical and surgical therapy is theoretically beneficial but not enough evidence to show effectiveness in improving fertility. Endometriosis adalah suatu penyakit ginekologis yang sering terjadi pada sedikitnya 10% wanita usia reproduksi. Sebanyak 25-50% wanita infertil menderita endometriosis dan 30-50% wanita endometriosis adalah infertil. Mekanisme bagaimana endometriosis mempengaruhi fertilitas belum dapat dijelaskan secara lengkap sehingga manajemen pasien dengan problem infertilitas masih kontroversial. Tujuan penulisan artikel ini adalah untuk membahas endometriosis kaitannya dengan infertilitas berikut penatalaksanaannya dengan cara studi kepustakaan. Dapat disimpulkan bahwa mekanisme terjadinya infertilitas karena endometriosis masih belum jelas, beberapa faktor diduga berperan dalam mekanisme tersebut yaitu distorsi anatomi, gangguan fungsi peritoneal, gangguan imunologis, abnormalitas endokrin dan ovarium serta gangguan implantasi. Penatalaksanaan infertilitas endometriosis sangat komplek dan harus mempertimbangkan aspek usia, lama infertilitas, riwayat keluarga endometriosis, nyeri pelvis dan stadium endometriosis. Terapi medikal cukup efektifuntuk mengurangi keluhan endometriosis tetapi tidak meningkatkan fekunditas dan fertilitas, sedangkan terapi bedah laparoskopi secara signifikan meningkatkan angka kehamilan dan angka kelahiran hidup. Kombinasi terapi medikal dan bedah secara teoritis menguntungkan tetapi belum cukup bukti yang menunjukkan efektifitasnya dalam meningkatkan fertilitas.