Role of Surgery in Endometriosis-Associated Subfertility (original) (raw)

2013, Seminars in Reproductive Medicine

A relation between endometriosis and subfertility has long been hypothesized based on epidemiologic evidence. In fact, in large published series, the prevalence of endometriosis among women with primary infertility was 9 to 50%, 1-3 compared with 1 to 7% among women undergoing tubal ligation (i.e., in subjects with proven fertility). 1,4-7 Moreover, the monthly fecundity rate in women with endometriosis has been reported to be reduced, ranging from 2% to 10%, 8 as compared with 15 to 20% in fertile couples. Unfortunately, these epidemiologic observations constitute the only indirect evidence available concerning the association between endometriosis and subfertility. In fact, although several pathogenic mechanisms have been hypothesized, whether anatomical, biochemical, or endocrine, a causal relation has not yet been clearly demonstrated. The poor correlation observed between endometriosis stage, as evaluated by the American Society for Reproductive Medicine (ASRM) classification and reproductive performance, 12,13 seems to support the hypothesis that the distortion of the pelvic anatomy is not the sole factor involved. It is most likely that endometriosis-related subfertility results from the coexistence of different biological conditions. 9