Infertility Associated to Endometriosis: Clarifying Some Important Controversies - Revista Brasileira de Ginecologia e Obstetrícia
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(9):523-524
Endometriosis is an estrogen-dependent gynecological disease characterized by the presence and growth of endometrial tissue (glands and/or stroma) outside the uterine cavity. The disease affects ∼ 10% of women of reproductive age and is strongly associated with infertility. It is estimated that more than 30% of infertile women have endometriosis and that 30 to 50% of these women report difficulties in getting pregnant.
Opinion remains divided as to whether minor endometriosis (minimal and mild endometriosis—stages I and II, respectively) has an adverse effect on the likelihood of conception. In 1998, a study demonstrated that the fecundity of infertile women with minimal or mild endometriosis is not significantly lower than that of women with unexplained infertility, suggesting that the initial stage of the disease is just a finding and not the cause of infertility. Otherwise, the findings of a randomized controlled trial showing improved natural conception rates following surgical treatment of visible endometriotic lesions suggest that the presence of visible minor lesions alone may have an adverse effect on natural conception. Additionally, a retrospective study of 192 fully investigated infertile couples (117 women with unexplained infertility and 75 with minimal/mild endometriosis without adhesive disease, both managed conservatively after diagnostic laparoscopy) evaluated cumulative pregnancy rates in both groups followed up for up to 3 years following laparoscopy. This study demonstrated that women with endometriosis had a lower probability of pregnancy compared with women with unexplained infertility (36% versus 55%, respectively), which confirmed the presence of lower cumulative pregnancy rates in women in the early stages of endometriosis compared with women with infertility of unknown cause, thus supporting the association between infertility and endometriosis in the early stages.
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Endometriosis is an estrogen-dependent gynecological disease characterized by the presence and growth of endometrial tissue (glands and/or stroma) outside the uterine cavity. The disease affects ∼ 10% of women of reproductive age and is strongly associated with infertility. It is estimated that more than 30% of infertile women have endometriosis and that 30 to 50% of these women report difficulties in getting pregnant.
Opinion remains divided as to whether minor endometriosis (minimal and mild endometriosis—stages I and II, respectively) has an adverse effect on the likelihood of conception. In 1998, a study demonstrated that the fecundity of infertile women with minimal or mild endometriosis is not significantly lower than that of women with unexplained infertility, suggesting that the initial stage of the disease is just a finding and not the cause of infertility. Otherwise, the findings of a randomized controlled trial showing improved natural conception rates following surgical treatment of visible endometriotic lesions suggest that the presence of visible minor lesions alone may have an adverse effect on natural conception. Additionally, a retrospective study of 192 fully investigated infertile couples (117 women with unexplained infertility and 75 with minimal/mild endometriosis without adhesive disease, both managed conservatively after diagnostic laparoscopy) evaluated cumulative pregnancy rates in both groups followed up for up to 3 years following laparoscopy. This study demonstrated that women with endometriosis had a lower probability of pregnancy compared with women with unexplained infertility (36% versus 55%, respectively), which confirmed the presence of lower cumulative pregnancy rates in women in the early stages of endometriosis compared with women with infertility of unknown cause, thus supporting the association between infertility and endometriosis in the early stages.
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