Surgical management of endometriosis to optimize fertility

Author:

Hamilton Kacey M.1,VanHise Katherine2,Truong Mireille D.1,Wright Kelly N.1,Siedhoff Matthew T.1

Affiliation:

1. Division of Minimally Invasive Gynecologic Surgery

2. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California, USA

Abstract

Purpose of review Surgery is an integral element of treatment for infertility caused by endometriosis. This review summarizes the purported mechanisms of infertility in endometriosis, as well as the impacts of surgery for endometriosis on fertility, including pregnancy achieved spontaneously and with assisted reproductive technology (ART). Recent findings Endometriosis’ effect on fertility is multifactorial. The sequela of increased inflammation resulting from endometriosis causes alterations in ovarian, tubal, and uterine function. Removing or destroying these lesions reduces inflammation. Surgical treatment of both early-stage endometriosis and deeply infiltrating endometriosis improves spontaneous pregnancy rates and ART pregnancy rates. Conventional or robotic laparoscopy is the preferred surgical approach. Summary Endometriosis has detrimental effects on fertility, including negative impacts on oocyte, tubal, and endometrial function. Laparoscopic surgery for endometriosis elevates both spontaneous and ART pregnancy rates above those achieved with expectant management alone. The resection or destruction of endometriosis implants reduces inflammation, which likely improves the multifactorial infertility related to endometriosis. This topic is complex and controversial; more research in the form of high-quality randomized control trials is needed.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Obstetrics and Gynecology

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Analysis of factors affecting pregnancy rate after laparoscopic surgery for infertility associated with endometriosis;European Journal of Obstetrics & Gynecology and Reproductive Biology;2024-06

2. The dilemma of management of patients with endometrioma and infertility;Russian Journal of Human Reproduction;2024

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