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Endometriosis is an estrogen-dependent disease that affects between 10% and 15% of reproductive-age women.
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There is a well-established association between endometriosis and infertility; however, causes seem to be multifactorial, involving mechanical, molecular, genetics, and environmental causes.
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The optimal method for treatment of endometriosis-associated infertility is an individualized decision that should be made on patient-specific basis.
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In vitro fertilization is currently the most effective
Endometriosis and Infertility: A Review of the Pathogenesis and Treatment of Endometriosis-associated Infertility
Section snippets
Key points
Endometriosis: overview
Endometriosis is an estrogen-dependent benign inflammatory disease characterized by the presence of ectopic endometrial implants.8 Implants typically occur in the pelvis but have also been seen in the upper abdomen, peripheral and axial skeleton, lungs, diaphragm, and central nervous system. The most common sites of endometriosis, in decreasing order, are the ovaries, anterior/posterior cul-de-sac, broad ligaments and uterosacral ligaments, uterus, fallopian tubes, sigmoid colon, and appendix.
Pathogenesis of endometriosis
The definite pathogenesis of endometriosis is still unknown but there are several leading theories, including retrograde menstruation, altered immunity, coelomic metaplasia, and metastatic spread. Newer research is also proposing stem cell and genetic origins of the disease.
Endometriosis-associated infertility
Here we discuss the current evidence and proposed mechanisms regarding how endometriosis adversely impacts fertility. It is clear how severe disease can cause infertility. Pelvic anatomy becomes distorted and fecundity is reduced via mechanical disruptions such as pelvic adhesions. These disruptions impair oocyte release or pick-up, alter sperm motility, cause disordered myometrial contractions, and impair fertilization and embryo transport.33 Women who are infertile are more likely to have
Treatment of endometriosis-associated infertility
Current treatment of endometriosis-associated infertility focuses on improving fecundity by removing or reducing ectopic endometrial implants and restoring normal pelvic anatomy.50 A wide spectrum of treatment options have been examined, including expectant management, medical treatment, surgical treatment, and assisted reproductive technology (ART). Current research is also examining novel promising nonhormonal treatment options for endometriosis such as immunoconjugate, VEGF antagonists, and
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