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This review examines the pathogenesis of endometriosis, including peritoneal implantation and ovarian metaplasia, alongside its mechanisms for causing infertility. The authors note that while laparoscopy remains the diagnostic standard, surgical removal of mild disease does not significantly improve fertility rates compared to expectant management. For advanced stages, surgical reconstruction offers pregnancy rates of 40-60%, whereas drug therapy alone fails to enhance fertility outcomes beyond those achieved by assisted reproductive technologies following failed surgery. This paper is centrally about endometriosis — specifically addressing its pathological classification, diagnostic approaches via laparoscopy, and therapeutic strategies for associated infertility.
Abstract
INTRODUCTION: Endometriosis is frequent in infertile women, but the relation between these two conditions has still remained unclear. Our intention was to present the pathogenesis of endometriosis, mechanism of the associated infertility and a rational approach to treatment of this frequent medical problem.
PATHOGENESIS OF ENDOMETRIOSIS: The peritoneal form is most probably generated by implantation of the endometrium by menstrual reflux. Endometriomas are most probably formed by invagination and metaplasia of the ovarian mesothelium or by metaplasia of the epithelium of inclusion cysts. Adenomyosis of the rectovaginal septum develops from embryonic remnants of the Mullerian ducts.
DIAGNOSIS: Laparoscopy is a method of choice which provides safe diagnosis, estimation of the disease and is an optimal method of treatment.
PATHOGENESIS AND THERAPY OF INFERTILITY: The relation between mild forms of disease (Stage I and II) and infertility has remained unclear. Surgical removal of ectopic foci does not affect female fertility. The expectant treatment during one to four years has been followed by pregnancy in 50% of patients. In patients with III and IV stage disease, there is a frequent mechanical cause of infertility. Expectant treatment was followed by 25% incidence of pregnancy in patients with stage III disease and 0% in patients with stage IV endometriosis. Surgical reconstruction of normal anatomical relations resulted in pregnancy in 40-60% of patients. Administration of any drug therapy, either single or combined with surgical treatment does not increase the fertility rate. Methods of assisted reproduction are alternative approaches to treatment and they have to be administered after unsuccessful surgical treatment. Pretreatment with GnRH agonists increases the efficacy of in vitro fertilization.
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Medicinski pregled 2002 Volume 55, Issue 3-4, Pages: 120-124 Endometriosis and infertility Pjević Mirko (Klinički centar, Novi Sad - Klinika za ginekologiju i akušerstvo) Introduction Endometriosis is frequent in infertile women, but the relation between these two conditions has still remained unclear. Our intention was to present the pathogenesis of endometriosis, mechanism of the associated infertility and a rational approach to treatment of this frequent medical problem. Pathogenesis of endometriosis The peritoneal form is most probably generated by implantation of the endometrium by menstrual reflux. Endometriomas are most probably formed by invagination and metaplasia of the ovarian mesothelium or by metaplasia of the epithelium of inclusion cysts. Adenomyosis of the rectovaginal septum develops from embryonic remnants of the Mullerian ducts. Diagnosis Laparoscopy is a method of choice which provides safe diagnosis, estimation of the disease and is an optimal method of treatment. Pathogenesis and therapy of infertility The relation between mild forms of disease (Stage I and II) and infertility has remained unclear Surgical removal of ectopic foci does not affect female fertility. The expectant treatment during one to four years has been followed by pregnancy in 50% of patients. In patients with III and IV stage disease, there is a frequent mechanical cause of infertility. Expectant treatment was followed by 25% incidence of pregnancy in patients with stage III disease and 0% in patients with stage IV endometriosis. Surgical reconstruction of normal anatomical relations resulted in pregnancy in 40-60% of patients. Administration of any drug therapy, either single or combined with surgical treatment does not increase the fertility rate. Methods of assisted reproduction are alternative approaches to treatment and they have to be administered after unsuccessful surgical treatment. Pretreatment with GnRH agonists in-creases the efficacy of in vitro fertilization. Keywords: endometriosis + pathology + classification + diagnosis, infertility, female + therapy
https://doi.org/10.2298/MPNS0204120P
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Trninić-Pjević Aleksandra (Klinički centar, Novi Sad - Klinika za ginekologiju i akušerstvo)
Radulović Aleksandar (Klinički centar, Novi Sad - Klinika za ginekologiju i akušerstvo)
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