Endometriosis and Infertility - a consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence)

Endometriosis is common in women with infertility but its management is controversial and varied. This article summarises the consensus developed by a group of Australasian subspecialists in reproductive endocrinology and infertility (the Australasian CREI Consensus Expert Panel on Trial evidence gr...

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Bibliographic Details
Published in:Australian & New Zealand journal of obstetrics & gynaecology 2012-12, Vol.52 (6), p.513-522
Main Authors: Koch, Juliette, Rowan, Katrina, Rombauts, Luk, Yazdani, Anusch, Chapman, Michael, Johnson, Neil
Format: Article
Language:English
Subjects:
assisted reproductive technology
endometriosis
Endometriosis - complications
Endometriosis - drug therapy
Endometriosis - surgery
Female
Fertilization in Vitro
Humans
in vitro fertilisation
infertility
Infertility, Female - complications
Infertility, Female - therapy
Insemination, Artificial
Ovulation Induction
Pregnancy
Pregnancy Rate
Recurrence
surgery
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Summary:Endometriosis is common in women with infertility but its management is controversial and varied. This article summarises the consensus developed by a group of Australasian subspecialists in reproductive endocrinology and infertility (the Australasian CREI Consensus Expert Panel on Trial evidence group) on the evidence concerning the management of endometriosis in infertility. Endometriosis impairs fertility by causing a local inflammatory state, inducing progesterone resistance, impairing oocyte release and reducing sperm and embryo transport. Medical treatments have a limited role, whereas surgical and assisted reproductive treatments improve pregnancy rates. The role of surgery for deep infiltrative endometriosis and repeat surgery requires further evaluation and there is insufficient evidence for the use of anti‐adhesives to improve fertility. Intrauterine insemination (IUI) and in vitro fertilisation (IVF) improve pregnancy rates but women with endometriosis have lower pregnancy rates than those with other causes of infertility. The decision about whether to operate or pursue assisted reproduction will depend on a variety of factors such as the patient's symptoms, the presence of complex masses on ultrasound, ovarian reserve and ovarian access for IVF, risk of surgery and cost. Some women with infertility and endometriosis may benefit from a combination of assisted reproduction and surgery.
ISSN:0004-8666
1479-828X
DOI:10.1111/j.1479-828X.2012.01480.x