An update on endometriosis associated subfertility: what does the most recent evidence say?

In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2018 · vol. 7(12) , pp. 5226 · doi:10.18203/2320-1770.ijrcog20185000 · W2902201114
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AI-generated summary by claude@2026-06, 2026-06-13

This review of recent literature finds that medical management, surgical approaches, or a combination thereof improve spontaneous pregnancy rates for women with endometriosis-associated subfertility.

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This article is an evidence update reviewing published literature on endometriosis-associated subfertility, drawing on higher-level sources such as Cochrane reviews and guidance from ESHRE, ACOG, NICE, and BMJ best practice. It synthesizes evidence on medical management, surgical approaches, and combined strategies for women with endometriosis who are subfertile, reporting that these interventions improve spontaneous pregnancy rates in this patient cohort. A key limitation is that the paper is a review rather than new primary research, and it does not provide a uniform quantitative meta-analysis across all included topics. This paper is centrally about endometriosis — it focuses specifically on endometriosis-associated subfertility and what the most recent evidence says about management options.

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Abstract

Endometriosis is a chronic debilitating disease that affects 10% of women in the reproductive age. Women with endometriosis present with pain, subfertility or both. The prevalence of endometriosis in women with subfertility is estimated to be within the range of 40%-50%. This is a review of the evidence published in the literature. The review was conducted via searching the databases of the Cochrane reviews, European Society of Human Reproduction and Embryology (ESHRE), American Society of Obstetrics and Gynaecology (ACOG), National Institute for Clinical Excellence (NICE) and British Medical Journal (BMJ) best practice articles. Management of women with endometriosis and subfertility has been extensively assessed in the literature. Medical management, surgical approaches and a combination of both improve the spontaneous pregnancy rates for this cohort of patients.
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An update on endometriosis associated subfertility: what does the most recent evidence say? DOI: https://doi.org/10.18203/2320-1770.ijrcog20185000Keywords: Endometriosis, Laparoscopy, SubfertilityAbstract Endometriosis is a chronic debilitating disease that affects 10% of women in the reproductive age. Women with endometriosis present with pain, subfertility or both. The prevalence of endometriosis in women with subfertility is estimated to be within the range of 40%-50%. This is a review of the evidence published in the literature. The review was conducted via searching the databases of the Cochrane reviews, European Society of Human Reproduction and Embryology (ESHRE), American Society of Obstetrics and Gynaecology (ACOG), National Institute for Clinical Excellence (NICE) and British Medical Journal (BMJ) best practice articles. Management of women with endometriosis and subfertility has been extensively assessed in the literature. Medical management, surgical approaches and a combination of both improve the spontaneous pregnancy rates for this cohort of patients. Metrics References Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2014;(3):CD009590. BMJ best practice article on Endometriosis. 2018. Available at: https://www.bmj.com/content/323/7304/93. Management of women with endometriosis. ESHRE Endometriosis Guideline Development Group. September 2013. Available at: https://www.eshre.eu/~/media/sitecore-files/Guidelines/Endometriosis/ESHRE-guideline-on-endometriosis-2013.pdf. Ozkan S, Murk W, Arici A. Endometriosis and Infertility. Epidemiology and evidence based treatments. Annals New York Academy Sci. 2008;1127:92-100. Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D'Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril. 2009;92:68-74. Peterson CM, Johnstone EB, Hammoud AO, Stanford JB, Varner MW, Kennedy A, et al. Risk factors associated with endometriosis: importance of study population for characterizing disease in the ENDO Study. Am J Obstet Gynecol. 2013;208(6):451-e1. Marsh EE, Laufer MR. Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly. Fertil Steril. 2005;83(3):758-60. Al Kadri H, Hassan S, Al-Fozan HM, Hajeer A. Hormone therapy for endometriosis and surgical menopause. Cochrane Database Syst Rev. 2009;(1):CD005997. Leyland N, Casper R, Laberge P, Singh SS, Allen L, Arendas K, et al. Endometriosis: diagnosis and management. J Endometriosis. 2010;2(3):107-34. Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Malspeis S, Willett WC, et al. Reproductive history and endometriosis among premenopausal women. Obstet Gynecol. 2004;104(5 Pt 1):965-74. Ballard K, Lowton K, Wright J. What's the delay? A qualitative study of women's experiences of reaching a diagnosis of endometriosis. Fertil Steril. 2006;86:1296-301. Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;(2):CD009591. Guerriero S, Ajossa S, Minguez JA, Jurado M, Mais V, Melis GB, et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015;46(5):534-45. Stratton P, Winkel C, Premkumar A, Chow C, Wilson J, Hearns-Stokes R, et al. Diagnostic accuracy of laparoscopy, magnetic resonance imaging, and histopathologic examination for the detection of endometriosis. Fertil Steril. 2003;79:1078-85. Chapron C, Vieira M, Chopin N, Balleyguier C, Barakat H, Dumontier I, et al. Accuracy of rectal endoscopic ultrasonography and magnetic resonance imaging in the diagnosis of rectal involvement for patients presenting with deeply infiltrating endometriosis. Ultrasound Obstet Gynecol. 2004;24(2):175-9. Mol BW, Bayram N, Lijmer JG, Wiegerinck MA, Bongers MY, van der Veen F, et al. The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis. Fertil Steril. 1998;70:1101-8. Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow DM, Vandekerckhove P. Ovulation suppression for endometriosis for women with subfertility. Cochrane Database Syst Rev 2007:CD000155. Nezhat C, Crowgey S, Nezhat F. Videolaseroscopy for the treatment of endometriosis associated with infertility. Fertil Steril. 1989; 51:237-40. Vercellini P, Fedele L, Aimi G, De Giorgi O, Consonni D, Crosignani PG. Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system. Hum Reprod. 2006;21:2679-85. Endometriosis: diagnosis and management. National Institute for Clinical Excellence (NICE) guideline. 2017. Available at: nice.org.uk/guidance/ng73. Busacca M, Chiaffarino F, Candiani M, Vignali M, Bertulessi C, Oggioni G, et al. Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis. Am J Obstet Gynecol. 2006;195(2):426-32. Furness S, Yap C, Farquhar C, Cheong YC. Pre and post-operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev. 2004:CD003678. Benaglia L, Somigliana E, Santi G, Scarduelli C, Ragni G, Fedele L. IVF and endometriosis-related symptom progression: insights from a prospective study. Hum Reprod. 2011;26:2368-72. Saraswat L, Ayansina DT, Cooper KG, Bhattacharya S, Miligkos D, Horne AW. Pregnancy outcomes in women with endometriosis: a national record linkage study. BJOG. 2017;124(3):444-52.

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