Treatment options for infertility due to endometriosis

This article reviewed treatment options for women with infertility due to endometriosis (EM).

Endometriosis (EM) is a disorder where cells from the lining of the womb grow outside the uterus. These cells form lesions, which can be found on the ovaries, fallopian tubes, or the intestines. EM can be treated with hormonal medications or with surgery to remove the lesions.

Because EM lesions can affect how well the ovaries function, it is also one cause of infertility. 30 to 50% of women with EM also have infertility. It is not clear what is the best way to treat infertility due to EM.

EM lesions can physically damage the ovaries. EM also causes inflammation, which can interfere with normal ovary function. As a result, women with EM may have low numbers of eggs. The number of eggs can be measured using AFC levels or AMH levels. AFC measures how many follicles are present (structures in the ovaries that produce eggs). AMH is a hormone released by these follicles. Women with moderate or severe EM have lower AFC and AMH levels.

Surgery is one treatment option for women with infertility due to EM. One method is to surgically remove the lesions. Another method called electrical coagulation aims radio waves at the lesions to kill the cells. This technique can decrease the number of remaining eggs but improves pregnancy rates. In a study of 42 patients, more patients who had the surgery were able to become pregnant 3 years later (47% vs 33%).

Intrauterine insemination (IUI) is one infertility treatment that may help women with EM. When done after surgery, IUI is similarly successful in women with mild EM compared to women with other causes of infertility. However, IUI is not recommended for women with moderate or severe EM.

In vitro fertilization (IVF) is another infertility treatment that may help women with EM. Some studies have found that women with mild EM have similar pregnancy rates after IVF compared to women with other causes of infertility. Moderate to severe EM may lower the success of IVF. However, it is unclear if surgery before IVF can improve outcomes for these patients.

This article reviewed treatment options for women with infertility due to endometriosis (EM). Surgery, IUI, and IVF are all potential treatment options for these patients.