Case Report: Two clinical cases of severe deep infiltrating endometriosis with infertility—transplantation first or surgery first? Natural cycle or artificial cycle?

Fei Tang, Ye He, Peipei Guo, Yue Wang, Yunyun Liu, Liting Wang, Yi Wang, Pengxiang Xie, Panshi Xie, Youyan Fang, Caihua Li, Zhaojuan Yu, Xuqing Li, Zhaolian Wei
Frontiers in medicine · 2025 · vol. 12 , pp. 1725614 · doi:10.3389/fmed.2025.1725614 · PMID:41476869 · PMC12748218 · W4417354573
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This report details two successful pregnancies in patients with severe deep infiltrating endometriosis and infertility, achieved through embryo cryopreservation, laparoscopic surgery, and natural-cycle frozen embryo transfer.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes two infertility cases caused by severe deep infiltrating endometriosis (DIE) with rectal involvement (case 1) or ureteral/urinary tract involvement with hydronephrosis (case 2), managed using a sequential strategy of fertility preservation by embryo cryopreservation, definitive laparoscopic surgery to resect DIE, and subsequent frozen embryo transfer in a natural cycle. Both patients underwent IVF first to cryopreserve embryos, then had extensive laparoscopic procedures (including rectal resection/anastomosis in case 1 and ureteral-bladder anastomosis with additional pelvic/intestinal adhesiolysis and rectal resection in case 2), followed by postoperative GnRH-a or dienogest; CA125 levels declined and pelvic symptoms markedly improved. Each patient then achieved a pregnancy via natural-cycle frozen embryo transfer (single blastocyst), resulting in live births. The paper’s limitation is that conclusions are based on only two cases, so the strategy’s effectiveness and optimal sequencing cannot be established. This paper is centrally about endometriosis—specifically sequential ART, radical surgery, and natural-cycle frozen embryo transfer for severe deep infiltrating endometriosis-associated infertility.

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Abstract

Deep infiltrating endometriosis (DIE) is a severe condition frequently linked to infertility, yet the optimal integration of surgery and assisted reproductive technology (ART) remains controversial. This study reports two cases of infertility secondary to severe rectal DIE that achieved live births through a tailored, sequential strategy. The management paradigm consisted of three phases: (1) fertility preservation via embryo cryopreservation, (2) definitive laparoscopic surgical resection, and (3) a natural-cycle frozen embryo transfer (NC-FET). Postoperatively, both patients demonstrated a significant decline in CA125 levels and substantial clinical improvement. The first case involved a 27-year-old with primary infertility, while the second, more complex case involved a 31-year-old with ureteral DIE and hydronephrosis, requiring multidisciplinary surgery. These cases illustrate that an integrated approach, which strategically combines preoperative fertility preservation, radical surgery to rectify pelvic anatomy, and a physiological, hormone-free embryo transfer, can optimize the likelihood of achieving pregnancy in patients with symptomatic infertility due to severe DIE.

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Outcome instruments

VAS-pain

Condition tags

endometriosisdie_deep_infiltratinginfertility

Citation neighborhood

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.

References (23)

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