How is subfertility managed in endometriosis?

Updated: May 10, 2021
  • Author: G Willy Davila, MD; Chief Editor: Michel E Rivlin, MD  more...
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Peritubal and periovarian adhesions can interfere mechanically with ovum transport and contribute to subfertility. Peritoneal endometriosis has been postulated to contribute to subfertility by interfering with tubal motility, folliculogenesis, and corpus luteum function. Aromatase is believed to increase the prostaglandin E levels via increase in the cyclooxygenase-2 (COX-2) expression. Endometriosis may also cause subfertility by causing more sperm binding to the ampullary epithelium, thereby affecting sperm-endosalpingeal interactions. [59]

Medical treatment of minimal or mild endometriosis has not been shown to increase pregnancy rates. [60] Moderate to severe endometriosis should be treated surgically. [61]

Other options for achieving pregnancy include intrauterine insemination, superovulation, and in vitro fertilization. In a case-controlled study, pregnancy rates with intracytoplasmic sperm injection were not affected by the presence or extent of endometriosis. [62] Furthermore, other analyses have shown improvement with in vitro fertilization pregnancy rates with pretreatment of stage 3 and 4 endometriosis with gonadotropin-releasing hormone (GnRH) agonists.

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