Endometriosis and subfertility: is the relationship resolved?
There are many arguments to support the hypothesis that there is a causal relationship between the presence of endometriosis and subfertility. These arguments are reviewed in this article and include: (1) an increased prevalence of endometriosis in subfertile women compared with women of proven fertility; (2) a reduced monthly fecundity rate (MFR) in baboons with mild to severe (spontaneous or induced) endometriosis compared with those with minimal endometriosis or a normal pelvis; (3) a trend toward a reduced MFR in infertile women with minimal to mild endometriosis compared with women with unexplained infertility; (4) a dose-effect relationship: a negative correlation between the r-AFS stage of endometriosis and the monthly fecundity rate and crude pregnancy rate; (5) a reduced monthly fecundity rate and cumulative pregnancy rate after donor sperm insemination in women with minimal-mild endometriosis compared with those with a normal pelvis; (6) a reduced MFR after husband sperm insemination in women with minimal to mild endometriosis compared with those with a normal pelvis; (7) a reduced implantation rate per embryo after IVF in women with moderate to severe endometriosis compared with women with a normal pelvis; and (8) an increased monthly fecundity rate and cumulative pregnancy rate after surgical removal of minimal to mild endometriosis.
D'Hooghe
Thomas M
TM
Leuven University Fertility Center, Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Debrock
Sophie
S
Hill
Joseph A
JA
Meuleman
Christel
C
D000818:Animals; D004715:Endometriosis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000628:therapy; D007315:Insemination, Artificial; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D015995:Prevalence