Treatment of infertility associated with deep endometriosis: definition of therapeutic balances
Open accessAbstract
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 of pregnancy complications. In conclusion, clear recommendation for the management of infertile women with deep endometriosis cannot be extrapolated from the literature. The therapeutic decision should be based on a comprehensive evaluation that includes clinical history, instrumental findings, pain symptoms, risks of pregnancy complications, and the woman's wishes.
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ЕНДОМЕТРІОЗ: ДОСЯГНЕННЯ ТА ПИТАННЯ В СВІТОВИХ ДОСЛІДЖЕННЯХ
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- Authors
- Somigliana, E., & Garcia-Velasco, J. A.
- Affiliations
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- ORCID
- Somigliana, Edgardo
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 104
- Issue
- 4
- Pages
- 764-770
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2146078576
- Cited by
- 66
- References
- 63
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 7 · 2021: 5 · 2020: 7 · 2019: 5 · 2018: 11 · 2017: 11 · 2016: 7 · 2015: 2
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- deep infiltrating endometriosis, infertility, endometrioma, adhesion, adenomyosis, surgical treatment, in vitro fertilization, pregnancy complications, decidualization, endometriosis progression, treatment decision-making
- MeSH terms
- Endometriosis, Female, Fertilization in Vitro, Humans, Infertility, Female, Pregnancy, Severity of Illness Index, Pregnancy Rate
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