Endometriosis and infertility: Insights into the causal link and management strategies |
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| Affiliation: | 1. University Hospitals Leuven, Leuven University Fertility Center, Herestraat 49, 3000, Leuven, Belgium;2. Biomedical Sciences, KU Leuven (University of Leuven), Belgium;3. Global Medical Affairs Fertility, Research and Development, Healthcare, Merck KGaA, Darmstadt, Germany;1. Gynecological Surgery and Endometriosis Departmental Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, and Università degli Studi, Milano, Italy;2. Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Italy;3. Gynaecological Oncology Unit, Fondazione IRCCS Ca’ Granda, Italy;4. Pathology Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Italy;5. Infertility Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, and Università degli Studi, Milano, Italy;1. Division for Gynaecology and for Unit Reproductive Medicine, Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Faculty of Medicine of the Geneva University, Geneva, Switzerland;2. Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, University Paris Descartes, Paris, France;1. Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark;2. Department of Oncology, Rigshospitalet, Copenhagen, Denmark;3. Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark |
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| Abstract: | When evaluating the correlation between endometriosis and infertility with application of the evidence-based guidelines to establish causality in medicine, it becomes apparent that endometriosis causes infertility. This is supported by a strong and consistent association between the two in various settings (prevalence, natural conception, intrauterine insemination (IUI), and assisted reproductive technologies (ARTs)), evidence for a temporal relation, arguments for a dose-response gradient, and proven effects of the removal of lesions on infertility. Next to surgical treatment of endometriosis lesions, medically assisted reproduction treatments such as IUI and ART such as in vitro fertilization are cornerstones of the management of endometriosis-related infertility. Because the revised American Society for Reproductive Medicine (rASRM) staging system is poorly correlated with pregnancy rates as opposed to the Endometriosis Fertility Index (EFI), the latter should be used as the preferred clinical tool to counsel patients on their postoperative fertility management options. |
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| Keywords: | Endometriosis Infertility Causality Fertility treatment Prognosis |
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