Endometriosis and infertility

Abstract

Objective: To review the literature on endometriosis in its relationship with infertility.

Methodology: A search was carried out in PubMed/Medline, Hinari and Cochrane, with the terms Infertility, Endometriosis, Endometrioma, Laparoscopy, In vitro fertilization and Cistectomy. Articles in English, French and Spanish published between January 2000 and September 2010 including original research, review articles, and meta-analysis, were selected. Those dealing with physiopathology, etiology, clinical diagnosis and treatment of endometriosis in its relationship with infertility were chosen.

Results: Endometriosis is responsible for up to 15% of female infertility cases. Proven mechanisms are tubal blockage, adhesions and endometriomas. Overproduction of prostaglandins and cytokines could affect the ovaric, tubaric, and endometrial functions. In stages I and II surgical treatment is better than the pharmacological one. The latter consists of three cycles of clomiphene citrate plus intrauterine insemination.

If pregnancy is not achieved, gonadotropin injections plus intrauterine insemination should be used. If this also fails, in vitro fertilization (IVF) may be used.

Conclusion: Endometriosis affects fertility by proven mechanisms but some others not yet elucidated may be acting as well. Recent advances should be taken into account in order to offer patients the best possible treatment.