The effect of endometriosis on in vitro fertilization outcome.
OBJECTIVE
Endometriosis is a leading cause of pelvic pain and infertility. Implantation of endometrial cells to the peritoneal surface can lead to a spectrum of disease severity with the most severe causing extensive pelvic adhesions and anatomic distortion. Infertility can result from anatomic abnormalities as well proinflammatory cellular and immune factors. Treatment options for women seeking pregnancy include surgical removal and/or in vitro fertilization. The aim of this study was to review current literature on the pathogenesis of endometriosis and treatment options for infertility.


METHODS
Recent published articles regarding infertility and endometriosis have been reviewed analyzing PubMed and Cochrane databases.


RESULTS
In vitro fertilization (IVF) is a valid option for patients after surgical management has not restored fertility. IVF may be offered sooner to older patients or to those with more severe disease. It is unclear if prior surgical treatment has deleterious effects on IVF outcomes. It does appear, however, that surgical removal of endometriomas may lead to decreased ovarian reserve. This may not affect fertility outcomes.


CONCLUSIONS
Endometriosis is a leading cause of pelvic pain and infertility. The most accepted theory of how endometriosis develops is the retrograde transplant theory by Sampson, but a constellation of numerous other factors are involved. The gold standard for diagnosis is operative; therefore, the true prevalence of this disease is uncertain. Many women with endometriosis will seek fertility treatment. In this case if endometriosis is found, it should be treated.
Department of Obstetrics and Gynecology, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44159, USA.
M
M
Catenacci
T
T
Falcone
D000328:Adult; D004715:Endometriosis / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D006801:Humans; D010146:Pain / Q000453:epidemiology; D011247:Pregnancy