Endometriosis and IVF

Endometriosis is a common but still enigmatic gynecological disorder, affecting 3-43% of reproductive age women and is diagnosed in 6-10% of women undergoing assisted reproduction techniques (IVF/ICSI).

The unclear benefit of laparoscopic management of minimal/mild endometriosis associated infertility becomes needless in case of patients with stage I-II undergoing IVF/ICSI, since its application is not associated with increased pregnancy and live birth rates after IVF/ICSI.

As far as the impact of endometriotic cyst (Stage III-IV) on the outcome of in-vitro fertilization is concerned, the most recent meta-analysis (Chun Yang et al., RBM Online, 2015) clearly showed that its presence is associated with lower oocytes, lower MII oocytes and lower number of embryos, although the clinical pregnancy and live birth rates were comparable. On the other hand one should take into account the possible impact of surgery on ovarian reserve and, also, the rupture of the cyst during oocyte retrieval, which may lead to peritonitis.

Laparoscopic management of deep infiltrating endometriosis (DIE) showed inconsistent results with regard to achievement of pregnancy after IVF/ICSI. Obviously, the effective management of chronic pelvic pain in case of DIE represents the main indication for surgical approach.

Management decisions should be individualized, taking into account and other confounding infertility factors, age, ovarian reserve and preference of the patient, while it is more than obvious that the design of prospective, well-designed studies is of utmost importance.

George Pantos

Em. Professor of Obstetrics and Gynaecology, Aristotle University of Thessaloniki
Scientific Associate, FIVI Medically Assisted Reproduction Unit, Thessaloniki Medical Interbalkan Clinic