Gynaecological pathology and assisted reproductive treatment: can we increase the chances of successful treatment by optimising the pelvis?

Abstract

Key content: Pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts may have a negative impact on fertility and the success of assisted reproductive technology (ART). If pelvic pathologies are identified during the course of investigations for subfertility, information based on the latest available evidence should be provided so that individuals can make informed decisions about how they wish to proceed. In some situations, surgical intervention prior to ART is strongly recommended, but in others, the evidence is more limited/conflicting. Learning objectives: To learn more about how and why pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts affect fertility and outcomes following ART treatment. To understand when surgical intervention is (and equally is not) indicated in the management of different pelvic pathologies in women with subfertility who are contemplating ART. To appreciate the different options on how to manage women with different pelvic pathologies identified before and during an ART cycle. To smooth the transition between secondary/tertiary NHS care and ART providers so that women are given consistent advice and managed according to evidence based recommendations.