Endometriosis and infertility: pathophysiology and management

de Ziegler D, Dominique de Ziegler, Borghese B, Bruno Borghese, Chapron C, Charles Chapron
Lancet (London, England) · 2010 · vol. 376(9742) , pp. 730–738 · doi:10.1016/s0140-6736(10)60490-4 · PMID:20801404 · W2109250334
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This paper reviews the pathophysiology and management strategies for endometriosis, a condition often associated with infertility.

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Abstract

Endometriosis and infertility are associated clinically. Medical and surgical treatments for endometriosis have different effects on a woman's chances of conception, either spontaneously or via assisted reproductive technologies (ART). Medical treatments for endometriosis are contraceptive. Data, mostly uncontrolled, indicate that surgery at any stage of endometriosis enhances the chances of natural conception. Criteria for non-removal of endometriomas are: bilateral cysts, history of past surgery, and altered ovarian reserve. Fears that surgery can alter ovarian function that is already compromised sparked a rule of no surgery before ART. Exceptions to this guidance are pain, hydrosalpinges, and very large endometriomas. Medical treatment-eg, 3-6 months of gonadotropin-releasing hormone analogues-improves the outcome of ART. When age, ovarian reserve, and male and tubal status permit, surgery should be considered immediately so that time is dedicated to attempts to conceive naturally. In other cases, the preference is for administration of gonadotropin-releasing hormone analogues before ART, and no surgery beforehand. The strategy of early surgery, however, seems counterintuitive because of beliefs that milder non-surgical options should be offered first and surgery last (only if initial treatment attempts fail). Weighing up the relative advantages of surgery, medical treatment and ART are the foundations for a global approach to infertility associated with endometriosis.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Endometriosis Infertility, Female Algorithms Endometriosis Endometriosis Endometriosis Female Humans Infertility, Female Infertility, Female Reproductive Techniques, Assisted

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 (100)

Cited by (50)

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