Endometriosis and infertility

Ola, Bolarinde; Ledger, William L

doi:10.1383/wohm.2.1.15.58878

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Volume 2, Issue 1 , Pages 15-17, January 2005

Endometriosis and infertility

Bolarinde Ola
- Bolarinde Ola is a Royal College of Obstetricians and Gynaecologists Subspecialty Trainee in Reproductive Medicine at the Sheffield Teaching Hospital NHS Trust, UK. He qualified from the Universities of Ibadan, Nigeria and Birmingham, UK. His research interests include development and evaluation of diagnostic tests in obstetrics and gynaecology.
William L Ledger
- William L Ledger is Professor and Head of Reproductive Medicine, Jessop Wing, Royal Hallamshire Hospital, Sheffield, UK. He qualified from Oxford in 1985 and trained in Reproductive Medicine in Edinburgh, UK and Adelaide, Australia. He was an honorary consultant and reader in obstetrics and gynaecology in Oxford 1993–1999. He is currently Professor of Obstetrics and Gynaecology at the University of Sheffield.

Abstract

Endometriosis is characterized by the presence of endometrial glandular and stromal tissues outside the endometrium. It may present at any time between menarche and the menopause with a peak incidence in the mid-30s. Adenomyosis is a related condition in which active endometrium penetrates into the myometrium.

A putative link between presence of endometriosis and subfertility is supported by the following: (i) endometriosis is seen more frequently in infertile women (20–45%) than in fertile controls (5–10%), and (ii) the three-year cumulative conception rate is lower in women with endometriosis (36%) compared with a control group (55%). In severe endometriosis, coital frequency may be reduced and adhesions and endometriomas may distort the pelvic anatomy and disrupt normal ovarian function. However even women with mild endometriosis seem to have reduced rates of fertilisation, cleavage and implantation rates in both natural and stimulated cycles compared with controls. Although, there is evidence, linking endometriosis to infertility. Two recent randomized controlled trials (RCTs) testing the hypothesis that laparoscopic treatment of minimal/mild endometriosis will improve pregnancy rates failed to reach similar findings. The smaller Italian study did not show benefit, whilst the more robust Canadian collaborative trial did show improvement in fecundity following laparoscopic ablation of endometriotic lesions. When the two RCTs were combined, the pooled odds ratio suggested that a significant improvement in live birth rate is to be expected from surgical treatment (OR 1.64, 95% CI 1.05 to 2.57). Furthermore, in mild endometriosis, it has been shown that about half of cases may deteriorate; therefore, when coexisting with subfertility, early surgical treatment should be considered to improve chances of conception and prevent endometriosis from worsening.

Keywords: endometriosis , adenomyosis , endometrioma , epidemiology , pathogenesis , adhesion , peritoneal milieu , pregnancy , live birth rate