Impact of endometriosis and adenomyosis on the outcome of assisted reproduction

Abstract

Conjugal infertility is an important and prevalent public health problem. Female causal factors of infertility can be summarized as follows: tuboperitoneal factor (endometriosis, genital tract infections, other infectious processes); ovarian factor (polycystic ovarian syndrome, endometriosis, obesity, age, other diseases - endocrinopathies, autoimmune diseases, genetic diseases, behavioral and environmental factors); uterine factor (Müllerian malformations, fibroids, polyps, synechiae, endometritis, adenomyosis). The infertility treatment is basically performed using low (intrauterine insemination) and high (in vitro fertilization - IVF and intracytoplasmic sperm injection in a single - ICSI) techniques of complexity. Endometriosis is associated with primary or secondary infertility, but its prevalence is not yet fully established. The fertility rate for couples with association with endometriosis when compared to couples without the disease varies from 2-10% and 30%, respectively. The relationship between adenomyosis and infertility also remains uncertain, occurring between 1 to 4% of cases. Current approaches for the treatment of infertility associated with the presence of endometriosis include watchful waiting, laparoscopic removal of the lesions, controlled ovarian hyperstimulation with IVF or ICSI, oocyte and embryo cryopreservation or a combination of these treatments. Currently, IVF and ICSI are considered the most effective therapeutic procedures to treat infertility associated with endometriosis. There are conflicting findings concerning the impact of adenomyosis in assisted reproductive prognosis, although many retrospective cohort studies suggest that there is no deleterious impact of adenomyosis in the clinical pregnancy rates. However, there is great variation in the population studied and mainly in the degree of adenomyosis. Moreover, the presence of endometriosis itself becomes a confounding factor when assessing infertility in patients who have concomitant adenomyosis. Further data are needed to specify the extent of the association between adenomyosis and deep endometriosis seeking a better result in the use of assisted reproduction. (AU)