Endometriosis and ART

We recommend assisted reproductive technology (ART) to endometriosispatients with old ages and high duration of infertility,especially when other treatment have been unsuccessfuland also when we have other infertility causes such male FactorInfertility and any problems in tubal function are existence.In infertile woman with endometrioma larger than ۳ cm thereis no evidence that cystectomy prior to treatment with ART improvespregnancy rate.But if these cysts produce severe pain or some problem forovum pick up, We can do cystectomy but must know about riskof reduced ovarian function after surgery.The use of GnRH analog pituitary suppression with the socalled“long protocol” is the gold standard among the COH protocols.It should be used as the first line of treatment in womenwith good ovarian reserve.ESHRE guideline recommends GnRHa ۳-۶ month before ART,to improve pregnancy. But in special patient with low ovarianreserve we can use Antagonist Protocol. Antibiotic prophylaxisis recommended in these patients during oocyte retrieval.Most studies show that endometriosis affects number of retrievedoocyte but not embryo quality or pregnancy outcomeirrespective of the presence of an ovarian endometrioma. Miscarriageand obstetric complication are higher in patient specialwith severe endometriosis.ART did not exacerbate the symptoms of endometriosis or negativelyimpact on quality of life in women with endometriosisas compared with disease-free women.