Skip to main content

Endometriosis and infertility

Journal of Assisted Reproduction and Genetics volume 27, pages 441–447 (2010)Cite this article

Abstract

Endometriosis is a debilitating condition characterized by high recurrence rates. The etiology and pathogenesis remain unclear. Typically, endometriosis causes pain and infertility, although 20–25% of patients are asymptomatic. The principal aims of therapy include relief of symptoms, resolution of existing endometriotic implants, and prevention of new foci of ectopic endometrial tissue. Current therapeutic approaches are far from being curative; they focus on managing the clinical symptoms of the disease rather than fighting the disease. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. The benefits of these treatments have not been entirely demonstrated, particularly in terms of expectations that women hold for their own lives. Although theoretically advantageous, there is no evidence that a combination medical-surgical treatment significantly enhances fertility, and it may unnecessarily delay further fertility therapy. Randomized controlled trials are required to demonstrate the efficacy of different treatments.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Saridogan E, et al. ESHRE guideline on the diagnosis and management of endometriosis. Hum Reprod. 2005;20(10):2698–704.

    Article  PubMed  Google Scholar 

  2. Rock JA, Markham SM. Pathogenesis of endometriosis. Lancet. 1992;340:1264–7.

    Article  CAS  PubMed  Google Scholar 

  3. Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):789–99.

    Article  Google Scholar 

  4. Counsellor VS. Endometriosis. A clinical and surgical review. Am J Obstet Gynecol. 1938;36:877.

    Google Scholar 

  5. Hummelshoj L, Prentice A, Groothuis P. Update on endometriosis. Womens Health (Lond Engl). 2006;2(1):53–6.

    Google Scholar 

  6. Simoens S, Hummelshoj L, D’Hooghe T. Endometriosis: cost estimates and methodological perspective. Hum Reprod Update. 2007;13:394–404.

    Article  Google Scholar 

  7. Vercellini P, Trespidi L, De Giorgi O, Cortesi I, Parazzini F, Crosignani PG. Endometriosis and pelvic pain: relation to disease stage and localization. Fertil Steril. 1996;65:299–304.

    CAS  PubMed  Google Scholar 

  8. Gruppo italiano per lo studio dell’endometriosi. Prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: results from a multicentric Italian study. Hum Reprod. 1994;9(6):1158–62.

    Google Scholar 

  9. Berube S, Marcoux S, Maheux R. Characteristics related to the prevalence of minimal or mild endometriosis in infertile women. Canadian Collaborative Group on Endometriosis. Epidemiology. 1998;9:504–10.

    Article  CAS  PubMed  Google Scholar 

  10. Vessey MP, Villard-Mackintosh L, Painter R. Epidemiology of endometriosis in women attending family planning clinics. BMJ. 1993;306:182–4.

    Article  CAS  PubMed  Google Scholar 

  11. ACOG Practice Bullettin No 51. Chronic pelvic pain. Obstet Gynecol. 2004;103(3):589–605.

    Google Scholar 

  12. Schwartz D, Mayaux MJ. Female fecundity as a function of age: results of artificial insemination in 2193 nulliparous women with azoospermic husbands. CECOS. N Engl J Med. 1982;306(7):404–6.

    Article  CAS  PubMed  Google Scholar 

  13. Hughes EG, Fedorkow DM, Cllins JA. A quantitative overview of controlled trials in endometriosis-associated infertility. Fertil Steril. 1993;59:963–70.

    CAS  PubMed  Google Scholar 

  14. Collins JA, Burrows EA, Wilan AR. The prognosis for live birth among untreated infertile couples. Fertil Steril. 1995;64(1):22–8.

    CAS  PubMed  Google Scholar 

  15. Verkauf BS. The incidence, symptoms, and signs of endometriosis in fertile and infertile women. J Fla Med Assoc. 1987;74(9):671–5.

    CAS  PubMed  Google Scholar 

  16. Schenken RS, Asch RH, Williams RF, Hodgen GD. Etiology of infertility in monkeys with endometriosis: luteinized unruptured follicles, luteal phase defects, pelvic adhesions and spontaneous abortions. Fertil Steril. 1984;41:122–30.

    CAS  PubMed  Google Scholar 

  17. Practice Committee of the American Society for Reproductive Medicine (ASRM). Endometriosis and Infertility. Fertil Steril. 2006;14:S156–60.

    Google Scholar 

  18. Suginami H, Yano K. An ovum capture inhibitor (OCI) in endometriosis peritoneal fluid: an OCI-related membrane responsible for fimbrial failure of ovum capture. Fertil Steril. 1988;50:648–53.

    CAS  PubMed  Google Scholar 

  19. Bulletti C, Flamigni C, de Ziegler D. Implantation markers and endometriosis. Reprod Biomed Online. 2005;11(4):464–8.

    Article  PubMed  Google Scholar 

  20. Bulletti C, Flamigni C, de Ziegler D. Uterine contractility and embryo implantation. Curr Opin Obstet Gynecol. 2005;17(3):265–76. Corrected and republished in: Curr Opin Obstet Gynecol. 2006;18[4]:473–84.

    Article  PubMed  Google Scholar 

  21. Kunz G, Deninger H, Wild L, Leyendecker G. The dynamic of rapid sperm transport through the female genital tract: evidence from vaginal sonography of uterine peristalsis and hysterosalpingoscintigraphy. Hum Reprod. 1996;11:627–32.

    CAS  PubMed  Google Scholar 

  22. Bulletti C, Prefetto RA, Bazzocchi G, Romero R, Mimmi P, Flamigni C, et al. Electromechanical activities of human uteri during extra-corporeal perfusion with ovarian steroids. Hum Reprod. 1998;8:1558–63.

    Google Scholar 

  23. Bulletti C, de Ziegler D, Polli V, Diotallevi L, Del Ferro E, Flamigni C. Uterine contractility during menstrual cycle. Hum Reprod. 2000;15:81–9.

    PubMed  Google Scholar 

  24. Ijland MM, Evers JL, Dunselman GA, Hoogland HJ. Endometrial wavelike activity, endometrial thickness, and ultrasound texture in controlled ovarian hyperstimulation cycles. Fertil Steril. 1998;70(2):279–83.

    Article  CAS  PubMed  Google Scholar 

  25. IJland MM, Evers JL, Dunselman GA, Volovics L, Hoogland HJ. Relation between endometrial wavelike activity and fecundability in spontaneous cycles. Fertil Steril. 1997;67(3):492–6.

    Article  CAS  PubMed  Google Scholar 

  26. Dawood MY. Dysmenorrhea. Clin Obstet Gynecol. 1990;33(1):168–78.

    Article  CAS  PubMed  Google Scholar 

  27. Ishimaru T, Masuzaki H. Peritoneal endometriosis: endometrial tissue implantation as its primary etiologic mechanism. Am J Obstet Gynecol. 1991;165:210–4.

    Google Scholar 

  28. Salamanca A, Beltran E. Subendometrial contractility in menstrual phase visualized by transvaginal sonography in patients with endometriosis. Fertil Steril. 1995;64:193–5.

    CAS  PubMed  Google Scholar 

  29. Fanchin R, Righini C, Olivennes F. Uterine contractions at the time of embryo transfer alter pregnancy rates in in-vitro fertilization. Hum Reprod. 1998;13:1968–74.

    Article  CAS  PubMed  Google Scholar 

  30. Bulletti C, Dee Ziegler D, Polli V, Del Reffo F, Palini S, Flamini C. Characteristics of uterine contractility during menses in women with mild to moderate endometriosis. Fertil Steril. 2002;77(6):1156–61.

    Article  PubMed  Google Scholar 

  31. Bulletti C, De Ziegler D, Stefanetti M, Cicinelli E, Pelosi E, Flamigni C. Endometriosis: absence of recurrence in patients after endometrial ablation. Hum Reprod. 2001;16(12):2676–9. Erratum in: Hum Reprod 2002;17[3],844. Cincinelli E [corrected to Cicinelli E].

    Article  CAS  PubMed  Google Scholar 

  32. Huang HY. Medical treatment of endometriosis. Chang Gung Med J. 2008;31(5):431–40.

    PubMed  Google Scholar 

  33. Redwine DB. Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis and reoperation and persistent or recurrent disease. Fertil Steril. 1991;56:628–34.

    CAS  PubMed  Google Scholar 

  34. Chapron C, Dubuisson JB, Fritel X, Fernandez B, Poncelet C, Pinelli L, et al. Operative management of deep endometriosis infiltrating the uterosacral ligaments. J Am Assoc Gynecol Laparosc. 1999;6(1):31–7.

    Article  CAS  PubMed  Google Scholar 

  35. Sutton C, Hill D. Laser laparoscopy in the treatment of endometriosis. BJOG. 1990;97:181–5.

    Article  CAS  Google Scholar 

  36. Donnez J, Nisolle M, Gillerot S, Smets M, Bassil S, Casanas-Roux F. Rectovaginal septum adenomyotic nodules: a series of 500 cases. Br J Obstet Gynaecol. 1997;104(9):1014–8.

    CAS  PubMed  Google Scholar 

  37. Sutton CJ, Poley AS, Ewen SP, Haines P. Follow up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis. Fertil Steril. 1997;68:1070–4.

    Article  CAS  PubMed  Google Scholar 

  38. Davis GD. Management of endometriosis and its associated adhesions with the CO2 laser laparoscope. Obstet Gynecol. 1986;68(3):422–5.

    CAS  PubMed  Google Scholar 

  39. Crosignani PG, Vercellini P, Biffignandi F, Costantini W, Cortesi I, Imparato E. Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis. Fertil Steril. 1996;66(5):706–11.

    CAS  PubMed  Google Scholar 

  40. Bateman BG, Kolp LA, Mills S. Endoscopic versus laparotomy management for severe endometriosis. Fertil Steril. 1994;62:690–5.

    CAS  PubMed  Google Scholar 

  41. Busacca M, Fedele L, Bianchi S, Candiani M, Agnoli B, Vignali M, et al. Surgical treatment of recurrent endometriosis: laparotomy versus laparoscopy. Hum Reprod. 1998;13:2271–4.

    Article  CAS  PubMed  Google Scholar 

  42. Practice Committee of the American Societ for Reproductive Medicine (ASRM). Treatment of pelvic pain associated with endometriosis. Fertil Steril. 2006;86(5):S18–27.

    Article  Google Scholar 

  43. Marcoux S, Maheux R, Bérubé S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med. 1997;337(4):217–22.

    Article  CAS  PubMed  Google Scholar 

  44. Parazzini F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italian per lo Studio dell’Endometriosi. Hum Reprod. 1999;14(5):1332–4.

    Article  CAS  PubMed  Google Scholar 

  45. Adamson GD, Baker VL. Subfertility: causes, treatment and outcome. Best Pract Res Clin Obstet Gynaecol. 2003;17(2):169–85.

    Article  PubMed  Google Scholar 

  46. Aboulghar MA, Mansour RT, Serour GI, AI-Inany HG, Aboulghar MM. The outcome of in vitro fertilization in advanced endometriosis with previous surgery: a case-controlled study. Am J Obstet Gynecol. 2003;188(2):371–5.

    Article  PubMed  Google Scholar 

  47. Coccia ME, Rizzello F, Cammilli F, Bracco GL, Scarselli G. Endometriosis and infertility Surgery and ART: an integrated approach for successful management. Eur J Obstet Gynecol Reprod Biol. 2008;138(1):54–9. Epub 2008 Feb 20.

    Article  PubMed  Google Scholar 

  48. D’Hooghe T, Hummelshoj L. Multi-disciplinary centres/networks of excellence for endometriosis management and research: a proposal. Hum Reprod. 2006;21(11):2743–8.

    Article  PubMed  Google Scholar 

  49. Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman D, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698–704.

    Article  PubMed  Google Scholar 

  50. Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow D, Vandekerckhove P. Ovulation suppression for endometriosis (Cochrane Review). Cochrane Database Syst Rev. 2007;18(3):CD000155.

    Google Scholar 

  51. Jacobson TZ, Duffy JM, Barlow DH, Farquhar C, Koninckx PR, Olive D. Laparoscopic surgery for subfertility associated with endometriosis (Cochrane Review). Cochrane Database Syst Rev. 2010;20(1):CD001398.

    Google Scholar 

  52. Adamson GD, Hurd SJ, Pasta DJ, Rodriguez BD. Laparoscopic endometriosis treatment: is it better? Fertil Steril. 1993;59(1):35–44.

    CAS  PubMed  Google Scholar 

  53. Guzick DS, Silliman NP, Adamson GD, Buttram-VC J, Canis M, Schenken RS, et al. Prediction of pregnancy in infertile women based on the American Society for Reproductive Medicine’s revised classification of endometriosis. Fertil Steril. 1997;67(5):822–9.

    Article  CAS  PubMed  Google Scholar 

  54. Osuga Y, Koga K, Tsutsumi O, Yano T, Maruyama M, Taketani Y, et al. Role of laparoscopy in the treatment of endometriosis-associated infertility. Gynecol Obstet Invest. 2002;53 Suppl 1:33–9.

    Article  PubMed  Google Scholar 

  55. Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril. 1998;70(6):1176–80.

    Article  CAS  PubMed  Google Scholar 

  56. Chapron C, Vercellini P, Barakat H, Vieira M, Dubuisson JB. Management of ovarian endometriomas. Hum Reprod Update. 2002;8(6):591–7.

    Article  CAS  PubMed  Google Scholar 

  57. Vercellini P, Chapron C, De Giorgi O, Consonni D, Frontino G, Crosignani PG. Coagulation or excision of ovarian endometriomas? Am J Obstet Gynecol. 2003;188(3):606–10.

    Article  PubMed  Google Scholar 

  58. Rickes D, Nickel I, Kropf S, Kleinstein J. Increased pregnancy rates after ultralong postoperative therapy with gonadotropin-releasing hormone analogs in patients with endometriosis. Fertil Steril. 2002;78(4):757–62.

    Article  PubMed  Google Scholar 

  59. Surrey ES, Silverberg KM, Surrey MW, Schoolcraft WB. Effect of prolonged gonadotropin-releasing hormone agonist therapy on the outcome of in vitro fertilization–embryo transfer in patients with endometriosis. Fertil Steril. 2002;78(4):699–704.

    Article  PubMed  Google Scholar 

  60. Garcia-Velasco JA, Somigliana E. Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod. 2009;24(3):496–501. Epub 2008 Dec 4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Physiopathology of Reproduction, Cattolica’s General Hospital and University of Bologna, “Polo Scientifico Didattico di Rimini”, Bologna, Italy

    Carlo Bulletti

  2. University of Firenze, Firenze, Italy

    Maria Elisabetta Coccia

  3. Department of Obstetrics and Gynecology, Salesi Hospital, Polytechnic University of Marche, Ancona, Italy

    Silvia Battistoni

  4. Tecnobios Procreazione, Bologna, Italy

    Andrea Borini

Authors
  1. Carlo Bulletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Elisabetta Coccia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Silvia Battistoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Borini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlo Bulletti.

Additional information

Capsule

Endometriosis has a profound impact on quality of life, and developing a therapy that also improves fertility remains a challenge for clinicians and basic scientists.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bulletti, C., Coccia, M.E., Battistoni, S. et al. Endometriosis and infertility. J Assist Reprod Genet 27, 441–447 (2010). https://doi.org/10.1007/s10815-010-9436-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-010-9436-1

Keywords

  • Endometriosis
  • Dysmenorrhea
  • Dyspareunia
  • Uterine contractility
  • Infertility