Endometriosis & ART

Background: Endometriosis is a chronic, inflammatory, hormonal, immune, systemic andheterogeneous disease with three different phenotypes (superficial, ovarian endometrioma anddeep infiltrating endometriosis), which is associated with adenomyosis in 30% of patients.Endometriosis is clearly associated with infertility and 25% to 50% of infertile women haveendometriosis and that 50% to 60%of women with endometriosis are infertile. Impact ofendometriosis and its treatment on ART outcome and impact of ART on endometriosis is a matterof debate yet.Purpose: To review the literature on the reciprocal effect of endometriosis and ART outcome.Methods: Searching all the original articles, systematic reviews, & meta-analysis on the subject ofendometriosis in pubmed and web of science database.Result: The endometriosis phenotype seems to have no impact on clinical pregnancy rate and livebirth. An altered ovarian reserve and a previous surgery for endometriosis and/or endometriomaare associated with decreased response to COS and pregnancy rates. Symptomatic women withsevere endometriosis and repeated IVF implantation failures may benefit from extensivelaparoscopic surgery to improve IVF outcome. Adenomyosis, which is frequently associated withendometriosis independently and negatively affects ART outcomes, with reduced chances ofpregnancy and live birth as well as an increased risk of miscarriage. GnRH antagonist protocols aresuperior to GnRH agonist protocols in terms of lower cycle cancellation rates, and better oocytesquantity and quality. However, long GnRH agonist suppression is recommended before frozenthawedembryo transfer to reduce miscarriage rate and improve live birth rate.Conclusion: ART is the preferred treatment option for infertile women with bilateralendometriomas, who had previous endometriosis surgery, with advanced age, prolonged durationof infertility, and other associated infertility factors.