Endometriosis and Infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility

Endometriois has been associated with infertility, however the mechanism by which it affects fertility are still not fully understood. A recent systematic review by Marcer and Taylor from Yale Medial School has reported.

 

Current treatment options of endometriosis-associated infertility include surgery, superovulation with IUI, and IVF. It’s also discuss potential future treatments for endometriosis related infertility such as stem cells transplantation and immune therapy.

 

Endometriosis has been estimated to affect up to 10–15% of reproductive aged women (1). The association between endometriosis and infertility is well supported throughout the literature, but a definite cause-effect relationship is still controversial. The prevalence of endometriosis increases dramatically to as high as 25%–50% in women with infertility and 30–50% of women with endometriosis have infertility (2).

 

The fecundity rate in normal reproductive age couples without infertility is estimated to be around 15% to 20%, while the fecundity rate in women with untreated endometriosis is estimated to be anywhere from 2% to 10% (3, 4).

Endometriosis is an estrogen-dependent benign inflammatory disease characterized by the presence of ectopic endometrial implants (5).

 

Treatment of Endometriosis-Associated Infertility

Expectant Management

Medical Treatment

Surgical Treatment

Combined Medical and Surgical Treatment

Superovulation and Intrauterine Insemination

Assisted Reproductive Technology

 

Key Points

• Endometriosis is an estrogen-dependent disease that affects between 10%–15% of reproductive aged women
• There is a well-established association between endometriosis and infertility; however, as evidenced above, it appears to be multi-factorial involving mechanical, molecular, genetics, and environmental causes
• The optimal method for treatment of endometriosis-associated infertility is an individualized decision that should be made on patient-specific basis
• In vitro fertilization is currently the most effective treatment of endometriosis-associated infertility
• Mental health care support for couples and individual partners

 

References

1. Olive DL, Pritts EA. Treatment of endometriosis. The New England journal of medicine. 2001;345(4):266–275. 

2. Verkauf BS. Incidence, symptoms, and signs of endometriosis in fertile and infertile women. The Journal of the Florida Medical Association. 1987;74(9):671–675. 

3. Endometriosis and infertility: a committee opinion. Fertility and sterility. 2012;98(3):591–598. 

4. Hughes EG, Fedorkow DM, Collins JA. A quantitative overview of controlled trials in endometriosis-associated infertility. Fertility and sterility. 1993;59(5):963–970. 

5. Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789–1799.

 

Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012 Dec;39(4):535-49. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538128/

 

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