I-37: Medical Treatment of Endometriosis inInfertility

There is still not enough evidence that endometriosis per se and infertility are causally related. While extensive pelvic adhesions or the loss of ovarian tissue clearly bears out the causative role of endometriosis this is more difficult in other patients. Several randomized controlled trials and observational studies have in fact reported almost uniform negative results: • spontaneous pregnancy rates were comparable in patients with unexplained infertility with and without pelvic endometriosis;• medical and surgical “suppressive” treatments in patients with pelvic endometriosis did not convincingly change their fecundity; • donor insemination and IVF cycles in women with and without endometriosis did not produce different outcomes. Only a small donor insemination study seems to show an impairment of the quality of the oocytes produced by women with endometriosis. Even patients with rectovaginal implants have apparently normal fertility. Endometriotic ovarian cysts are found in 20-40% of women with endometriosis and may greatly alter the ovarian cortex structure leading to a significant decline of spontaneous and induced ovulation. The most severe defects of ovarian function are seen in cases with bilateral endometriosis. Surgical treatment of the cysts is also associated with a decline in spontaneous and induced ovulation. Frequently endometrioma recurs after ablation but long-term use of oral contraceptives offers specific protection against this risk.