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32 - Endometriosis-Associated Infertility

from PART II - INFERTILITY EVALUATION AND TREATMENT

Published online by Cambridge University Press:  04 August 2010

By
Cem S. Atabekoglu  and
Aydin Arici
Edited by
Botros R. M. B. Rizk ,
Juan A. Garcia-Velasco ,
Hassan N. Sallam  and
Antonis Makrigiannakis
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

INTRODUCTION

Endometriosis is a common pathological process that mostly occurs in the female pelvis. Despite a long history of clinical experience and experimental research, the pathogenesis and management of endometriosis still have a lot of uncertainty. Endometriosis is one of the most common gynecologic diseases affecting fertility potential of women. The prevalence of endometriosis in infertile women ranges from 20 to 55 percent, as compared with 2–5 percent of women undergoing tubal ligation (1, 2). This correlation has led many investigators and clinicians to the assumption that there is a causal relationship between these two entities. There is still no definite answer to the question concerning why patients with endometriosis have subfertility. Several explanations have been proposed for the etiology of infertility of patients with endometriosis. The most straightforward one is anatomical distortion present in advanced disease. However, affected women who have functional, patent tubes, with no anatomic distortion, may also be associated with infertility. Several others possibilities have been suggested, related to immunologic defects and altered characteristics of peritoneal fluid involving cytokines and macrophages, which may affect fertility by means of altered folliculogenesis, ovulatory dysfunction, reduced preovulatory steroidogenesis of granulosa cells, sperm phagocytosis, and impaired fertilization (3).

We do not expect to clarify these enigmas completely in this chapter, but we will try to illustrate different opinions regarding the pathophysiology and management of endometriosis-associated infertility according to the current knowledge.

Keywords

clomiphene citrateendometriosisGnRH agonistsin vitro fertilizationintracytoplasmic sperm injectionintrauterine inseminationlaparoscopic surgeryinfertilitypelvic inflammation
Type
Chapter
Information
Infertility and Assisted Reproduction , pp. 302 - 308
Publisher: Cambridge University Press
Print publication year: 2008

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References

Strathy, J, Molgaard, C, Coulam, C, Melton, LJ. Endometriosis and infertility: a laparoscopic study of endometriosis among fertile and infertile women. Fertil Steril 1982;38: 667–72.CrossRefGoogle ScholarPubMed
Suzuki, T, Izumi, S, Matsubayashi, H, Awaji, H, Yoshikata, K, Makino, T. Impact of ovarian endometrioma on oocytes and pregnancy outcome in in vitro fertilization. Fertil Steril 2005;83:908–13.CrossRefGoogle ScholarPubMed
Buyalos, RP, Agarwal, SK. Endometriosis-associated infertility. Curr Opin Obstet Gynecol 2000;12:377–81.CrossRefGoogle ScholarPubMed
D'Hooghe, TM, Debrock, S, Hill, JA, Meuleman, C., Endometriosis and subfertility: is the relationship resolved?Semin Reprod Med 2003;21:243–54.Google ScholarPubMed
D'Hooghe, TM, Bambra, CS, Koninckx, PR. Cycle fecundity in baboons of proven fertility with minimal endometriosis. Gynecol Obstet Invest 1994;37:63–5.CrossRefGoogle ScholarPubMed
D'Hooghe, TM, Bambra, CS, Raeymaekers, BM, et al. A prospective controlled study over 2 years shows a normal monthly fertility rate (MFR) in baboons with stage I endometriosis and a decreased MFR in primates with stage II–IV disease. Fertil Steril 1996;66:809–13.Google Scholar
Olive, DL, Stohs, GF, Metzger, DA, Franklin, RR. Expectant management and hydrotubations in the treatment of endometriosis-associated infertility. Fertil Steril 1985;44:35–42.CrossRefGoogle ScholarPubMed
Adamson, D. Surgical management of endometriosis. Semin Reprod Med 2003;21:224–33.Google ScholarPubMed
Marcoux, S, Maheux, R, Berube, S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 1997;337:217–22.CrossRefGoogle ScholarPubMed
Parazzini, F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell'Endometriosi. Hum Reprod 1999;14:1332–4.Google ScholarPubMed
Olive, DL. Endometriosis: does surgery make a difference?OBG Management 2002;14:56–70.Google Scholar
Muscato, JJ, Haney, AF, Weinberg, JB. Sperm phagocytosis by human peritoneal macrophages: a possible cause of infertility in endometriosis. Am J Obstet Gynecol 1982;144:503–10.CrossRefGoogle ScholarPubMed
Diaz, I, Navarro, J, Blasco, L, Simon, C, Pellicer, A, Remohi, J. Impact of stage III–IV endometriosis on recipients of sibling oocytes: matched case-control study. Fertil Steril 2000;74:31–4.CrossRefGoogle ScholarPubMed
Halis, G, Arici, A. Endometriosis and inflammation in infertility. Ann N Y Acad Sci 2004;1034:300–15.CrossRefGoogle ScholarPubMed
Minguez, Y, Rubio, C, Bernal, A, et al. The impact of endometriosis in couples undergoing intracytoplasmic sperm injection because of male infertility. Hum Reprod 1997;12:2282–5.CrossRefGoogle ScholarPubMed
Giudice, LC, Telles, TL, Lobo, S, Kao, L. The molecular basis for implantation failure in endometriosis: on the road to discovery. Ann N Y Acad Sci 2002;955:252–64.CrossRefGoogle ScholarPubMed
Dimitriadis, E, Stoikos, C, Stafford-Bell, M, et al. Interleukin-11, IL-11 receptor alpha and leukemia inhibitory factor are dysregulated in endometrium of infertile women with endometriosis during the implantation window. J Reprod Immunol 2006;69:53–64.CrossRefGoogle ScholarPubMed
Garcia-Velasco, JA, Nikas, G, Remohi, J, Pellicer, A, Simon, C. Endometrial receptivity in terms of pinopode expression is not impaired in women with endometriosis in artificially prepared cycles. Fertil Steril 2001;75:1231–3.CrossRefGoogle Scholar
Tanahatoe, SJ, Hompes, PGA, Lambalk, CB. Accuracy of diagnostic laparoscopy in the infertility work-up before intrauterine insemination. Fertil Steril 2003;79:361–6.CrossRefGoogle ScholarPubMed
Tanahatoe, SJ, Lambalk, CB, Hompes, PG. The role of laparoscopy in intrauterine insemination: a prospective randomized reallocation study. Hum Reprod 2005;20:3225–30.CrossRefGoogle ScholarPubMed
Calhaz-Jorge, C, Chaveiro, E, Nunes, J, Costa, AP. Implications of the diagnosis of endometriosis on the success of infertility treatment. Clin Exp Obstet Gynecol 2004;31:25–30.Google Scholar
Milingos, S, Protopapas, A, Kallipolitis, G, et al. Laparoscopic evaluation of infertile patients with chronic pelvic pain. Reprod Biomed Online 2006;12:347–53.CrossRefGoogle ScholarPubMed
Kennedy, S, Bergqvist, A, Chapron, C, et al.; on behalf of the ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005;20(10):2698–704.CrossRefGoogle Scholar
Berube, S, Marcoux, S, Langevin, M, Maheux, R. Canadian Collaborative Group on Endometriosis. Fecundity of infertile women with minimal or mild endometriosis and women with unexplained infertility. Fertil Steril 1998;69:1034–41.CrossRefGoogle ScholarPubMed
Sallam, HN, Garcia-Velasco, JA, Dias, S, Arici, A. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev 2006; 25(1):CD004635.Google ScholarPubMed
Adamson, GD, Pasta, DJ. Surgical treatment of endometriosis-associated infertility: meta-analysis compared with survival analysis. Am J Obstet Gynecol 1994;171:1488–505.CrossRefGoogle ScholarPubMed
Osuga, Y, Koga, K, Tsutsumi, O, et al. Role of laparoscopy in the treatment of endometriosis-associated infertility. Gynecol Obstet Invest 2002;53:33–9.CrossRefGoogle ScholarPubMed
Darai, E, Marpeau, O, Thomassin, I, et al. Fertility after laparoscopic colorectal resection for endometriosis: preliminary results. Fertil Steril 2005;84(4):945–50.CrossRefGoogle ScholarPubMed
Duepree, HJ, Senagore, AJ, Delaney, CP, Marcello, PW, Brady, KM, Falcone, T. Laparoscopic resection of deep pelvic endometriosis with rectosigmoid involvement. J M Coll Surg 2002;195:754–8.CrossRefGoogle ScholarPubMed
Hart, RJ, Hickey, M, Maouris, P, Buckett, W, Garry, R. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2005;3:CD004992.CrossRefGoogle Scholar
Alborzi, S, Momtahan, M, Parsanezhad, ME, Dehbashi, S, Zolghadri, J, Alborzi, SA. Prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril 2004;82:1633–7.CrossRefGoogle ScholarPubMed
Jones, KD, Sutton, CJ. Pregnancy rates following ablative laparoscopic surgery for endometriomas. Hum Reprod 2002;17: 782–5.CrossRefGoogle ScholarPubMed
Deaton, JI, Gibson, M, Blackmer, KM, et al. A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis. Fertil Steril 1990;54:1083–8.CrossRefGoogle ScholarPubMed
Peterson, CM, Hatasaka, HH, Jones, KP, Pouson, AM, Carrell, DT, Urry, RL. Ovulation induction with gonadotropins and intrauterine insemination compared with in vitro fertilization and no therapy: a prospective, non-randomized, cohort study and meta-analysis. Fertil Steril 1994;62:535–44.CrossRefGoogle Scholar
Fedele, L, Bianchi, S, Marchini, M, Villa, L, Brioschi, D, Parazzini, F. Superovulation with human menopausal gonadotropins in the treatment of infertility associated with minimal or mild endometriosis: a controlled randomized study. Fertil Steril 1992; 58(1):28–31.CrossRefGoogle ScholarPubMed
Al-Azemi, M, Bernal, AL, Steele, J, Gramsbergen, I, Barlow, D, Kennedy, S. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis. Hum Reprod 2000;15(1):72–5.CrossRefGoogle ScholarPubMed
Aboulghar, MA, Mansour, RT, Serour, GI, Al-Inany, HG, Aboulghar, MM. The outcome of in vitro fertilization in advanced endometriosis with previous surgery: a case-controlled study. Am J Obstet Gynecol 2003;188(2):371–5.CrossRefGoogle ScholarPubMed
Donnez, J, Wyns, C, Nisolle, M. Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin?Fertil Steril 2001;76:662–5.CrossRefGoogle ScholarPubMed
Garcia-Velasco, JA, Mahutte, NG, Corona, J, et al. Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case-control study. Fertil Steril 2004;81:1194–7.CrossRefGoogle ScholarPubMed
Suganuma, N, Wakahara, Y, Ishida, D, et al. Pretreatment for ovarian endometrial cyst before in vitro fertilization. Gynecol Obstet Invest 2002;54:36–40.CrossRefGoogle ScholarPubMed
Wong, BC, Gillman, NC, Oehninger, S, Gibbons, WE, Stadtmauer, . Results of in vitro fertilization in patients with endometriomas: is surgical removal beneficial?Am J Obstet Gynecol 2004;191:597–606.CrossRefGoogle ScholarPubMed
Pabuccu, R, Onalan, G, Goktolga, U, Kucuk, T, Orhon, E, Ceyhan, T. Aspiration of ovarian endometriomas before intracytoplasmic sperm injection. Fertil Steril 2004;82(3):705–11.CrossRefGoogle ScholarPubMed
Dicker, D, Goldman, JA, Feldberg, D, Ashkenazi, J, Levy, T. Transvaginal ultrasonic needle-guided aspiration of endometriotic cysts before ovulation induction for in vitro fertilization. J In Vitro Fert Embryo Trans 1991;8(5):286–9.CrossRefGoogle ScholarPubMed
Takuma, N, Sengoku, K, Pan, B, Wada, K, Tamauchi, T, Miyamoto, T, et al. Laparoscopic treatment of endometrioma-associated infertility and pregnancy outcome. Gynecol Obstet Invest 2002;54:30–5.CrossRefGoogle ScholarPubMed
Fisch, JD, Sher, G. Sclerotherapy with 5% tetracycline is a simple alternative to potentially complex surgical treatment of ovarian endometriomas before in vitro fertilization. Fertil Steril 2004;82(2):437–41.CrossRefGoogle ScholarPubMed
Maneschi, F, Marasa, L, Incandela, S, Mazzarese, M, Zupi, E. Ovarian cortex surrounding benign neoplasms: a histologic study. Am J Obstet Gynecol 1993;169(2):388–93.CrossRefGoogle ScholarPubMed
Muzii, L, Bianchi, A, Croce, C, Manci, N, Panici, PB. Laparoscopic excision of ovarian cysts: is the stripping technique a tissue- sparing procedure?Fertil Steril 2002;77(3):609–14.CrossRefGoogle ScholarPubMed
Hachisuga, T, Kawarabayashi, T. Histopathological analysis of laparoscopically treated ovarian endometriotic cysts with special reference to loss of follicles. Hum Reprod 2002;17(2):432–5.CrossRefGoogle ScholarPubMed
Pagidas, K, Falcone, T, Hemmings, R, Miron, P. Comparison of reoperation for moderate (stage III) and severe (stage IV) endometriosis-related infertility with in vitro fertilization-embryo transfer. Fertil Steril 1996;65(4):791–5.CrossRefGoogle ScholarPubMed
Fedele, L, Bianchi, S, Zanconato, G, Berlanda, N, Raffaelli, R, Fontana, E. Laparoscopic excision of recurrent endometriomas: long-term outcome and comparison with primary surgery. Fertil Steril 2006;85(3):694–9.CrossRefGoogle ScholarPubMed
Rizk, B and Abdalla, H. Surgery for Endometriosis. In: Rizk, B and Abdalla, H (Eds.) Endometriosis. Second edition. OxfordUnited Kingdom, Health Press, 2003; chapter 6, 84–86.Google Scholar

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