Endometriosis is the presence of endometrial like tissue (glands or stroma) outside the uterus. Its prevalence is estimated between 2 -10% in women of childbearing age. Patients with endometriosis may be asymptomatic, but they usually present with chronic pelvic pain and/or infertility. 30% to 50% of women with endometriosis have difficulties in getting pregnant. Clinical examination, ultrasounds and MRI may suspect endometriosis. Laparoscopy and histopathology confirm the diagnosis.
The management of infertility associated with endometriosis must follow a global approach evaluating pain, ovarian reserve, tubal and male factors and the stage of endometriosis. Several international guidelines (ASRM (2012), ESHRE (2013), and NICE(2017)) have been published. In patients with minimal and mild pelvic endometriosis (ASRM stage I or II), excision or ablation of the peritoneal endometriosis increases the pregnancy rate. For infertile women with ASRM stage I or II endometriosis, clinicians can recommend timed intercourse with controlled ovarian stimulation. Clinicians may consider IUI with controlled ovarian stimulation within 6 months after surgical treatment. Women with moderate or severe endometriosis (ASRM III or IV stage) must be directed to assisted reproduction technologies. In patients who have failed a primary surgery, assisted reproduction appears to be significantly more effective than repeat surgery.
If you are suffering from endometriosis and having difficulty in getting pregnant, please contact us to find out how we can help you.
