Treatment of infertility associated with deep endometriosis: definition of therapeutic balances

Fertility and Sterility
Edgardo Somigliana, Juan Antonio Garcia-Velasco

Abstract

Deep endometriosis is a demanding condition that is associated with infertility. However, evidence supporting a direct link between deep endometriosis and infertility is weak. In fact, infertility in affected patients is more likely to be explained by the strong association between deep endometriosis and adhesions, superficial endometriotic implants, ovarian endometriomas, and adenomyosis. The purported beneficial effects of surgery on infertility are mainly based on the 40%-42% pregnancy rate (PR) after surgery observed in published case series. However, this level of evidence is questionable and overestimates the benefits of the intervention. Even if comparative studies are lacking, IVF may be a valid alternative. The procedure may be less effective in affected women compared with other indications and it is not without additional deep endometriosis-related risks. Some case reports suggest that lesions might progress during IVF causing ureteral or intestinal complications or can decidualize during pregnancy causing intestinal perforation, pneumothorax, and pelvic vessels rupture. Finally, in the decision-making process, physicians should also consider that women with a history of deep endometriosis may face an increased risk ...Continue Reading

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Citations

Apr 14, 2016·European Journal of Obstetrics, Gynecology, and Reproductive Biology·Edgardo SomiglianaPaolo Vercellini
Aug 22, 2016·European Journal of Obstetrics, Gynecology, and Reproductive Biology·Nicola BerlandaPaolo Vercellini
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May 20, 2021·Minerva Obstetrics and Gynecology·Laura BenagliaEdgardo Somigliana
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