WHY WOMEN WITH ENDOMETRIOSIS NEED ART?

Endometriosis, the disease characterized by the presence of both functional endometrial glands and stroma outside of the uterine cavity, is usually related to infertility, even though the relationship is still being debated (1). As this disease is most likely observed in women of reproductive ages – although few cases have been described in adolescents and/or postmenopausal women – there is a strong interest in solving the problem on whether endometriosis and infertility are causally related, and if so, how can we help these women.

Although the prevalence of the disease is difficult to evaluate, it seems reasonable to state that there is an increased prevalence in subfertile women when compared with fertile women. But obviously, this does not mean that all women with endometriosis are infertile or need assisted reproduction (ART). In fact, there are women with endometriosis and with proven fertility. However, their fecundability or chances of achieving a pregnancy per month seems to be reduced.

The ideal study, comparing the fecundability of women with endometriosis (diagnosed by biopsy) with women without endometriosis (laparoscopically confirmed) would be unethical to perform. But from the baboon model, we have learned that their monthly fecundity rate (MFR) drops from 24 percent in baboons with normal pelvis to 18 percent if minimal endometriosis developed, and even lower if mild, moderate, or severe forms of the disease were present (2).