Assisted Reproduction and Endometriosis

The mechanisms by which endometriosis may compromise fertility and the roles of surgical and medical therapy are discussed in detail in earlier chapters. Appropriate surgical technique should overcome the mechanical distortion induced by endometriosis, but would not be expected to have a significant impact on the alterations in angiogenesis, cytokine regulation, and other inflammatory processes associated with this disease state. Similarly, traditional medical therapies, which may be beneficial for patients with symptomatic endometriosis, have not been demonstrated to enhance fecundity.1,2 In contrast, the assisted reproductive technologies (ART), which primarily include in vitro fertilization (IVF) and, to a lesser extent, gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT), should theoretically maximize the potential for conception by removing gametes and embryos in the early stages of development from an inhospitable peritoneal environment (Table 16.1). Similarly, abnormal pelvic anatomy, which may impede oocyte pickup and transport by the fallopian tube, can, in the case of IVF, be successfully bypassed.