title: Causes of endometriosis and prevalent infertility in patients undergoing laparoscopy without achieving pregnancy.
abstract: BACKGROUND
  Endometriosis is a disease with an unknown pathogenesis that can lead to infertility. Endometrial polyps, fibroids, and polycystic ovarian syndrome (PCOS) have relatively high frequency and are causes of infertility. We hypothesized a possible relationship between the presence of polyps, fibroids, and PCOS in infertile women with endometriosis who underwent laparoscopy and did not get pregnant, compared to women in the control group.
  
  
  METHODS
  This study was a cross-sectional study of 1243 infertile patients (621 with endometriosis and 622 controls). Endometriosis, Body Mass Index (BMI), infertility duration, age, and smoking habits were analyzed in relation to the presence of endometrial polyps, fibroids, and PCOS.
  
  
  RESULTS
  Polyps, 1.8 (95% CI 1.3-2.5); fibroids, 2.5 (95% CI 1.5-4.1); and PCOS, 1.0 (95% CI 0.6-1.6 were observed in the endometriosis group. A total of 285 patients (45.9%) were classified presenting endometriosis grades I and II, and 336 patients (54.1%) with grades III and IV. Our findings showed a significant association between the presence of fibroids in 129 women with endometriosis (20.8%), and in 69 (53.9%) with endometriosis grades III and IV (P=0:04). Among the 31 PCOS patients, 24 (77.4%) showed grades I and II (P<0.001).
  
  
  CONCLUSIONS
  Endometriosis and infertility are associated with the presence of polyps and fibroids. Furthermore, associations between the presence of fibroids with endometriosis grades III and IV, and presence of PCOS with grades I and II were observed.
authors.affiliation: Human Reproduction and Genetics Center Faculdade de Medicina do ABC, Instituto Ideia Fértil, Santo André, Brazil - oliveiraxl@hotmail.com.
authors.forename: Renato
authors.initials: R
authors.lastname: DE Oliveira
authors.forename: Fernando
authors.initials: F
authors.lastname: Adami
authors.forename: Fernanda A
authors.initials: FA
authors.lastname: Mafra
authors.forename: Bianca
authors.initials: B
authors.lastname: Bianco
authors.forename: Fabia L
authors.initials: FL
authors.lastname: Vilarino
authors.forename: Caio P
authors.initials: CP
authors.lastname: Barbosa
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004715:Endometriosis / Q000150:complications / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology / Q000209:etiology*; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000150:complications; D011085:Polycystic Ovary Syndrome / Q000150:complications; D011127:Polyps / Q000150:complications; D015995:Prevalence; D014594:Uterine Neoplasms / Q000150:complications