Endometriosis and IVF
Endometriosis is a common but enigmatic pathological entity, affecting 3 – 43% of women of reproductive age and occurring in 6 – 10% of women undergoing in vitro fertilization (IVF / ICSI).
While the impact of minimal or mild endometriosis (Stage I-II) on infertility is unclear, it is scientifically documented that laparoscopic treatment of endometriosis at these stages is not accompanied by an increase in pregnancy and live birth rates after IVF / ICSI and therefore should not be routinely recommended before IVF.
Regarding the impact of endometriosis cysts (Stage III-IV) on the outcome of IVF, the most recent meta-analysis (Chun Yang et al., RBM Online, 2015) showed that their presence is associated with a lower number of retrieved oocytes, a lower number of metaphase II oocytes, and also a lower number of formed embryos. However, the clinical pregnancy rate and live birth rates were similar.
On the other hand, the impact of surgery on ovarian reserves should be taken into account, as well as the possibility that an endometriosis cyst may rupture during retrieval, resulting in generalized inflammation.
The presence of deep endometriosis and its laparoscopic treatment have shown unclear results in achieving pregnancy after IVF/ICSI, and the conclusions of the literature are contradictory. Of course, the treatment of chronic pelvic pain in this case is the main indication for laparoscopic surgery.
The treatment of endometriosis in patients undergoing IVF/ICSI must be individualized, taking into account other concomitant causes of infertility, the patient’s age, ovarian reserves and her own choices, while the necessity of properly designed prospective studies is obvious.
