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• W1983295536 abstract "Endometriosis is a progressive disease that causes dyspareunia, dysmenorrhea, low back pain, and infertility (1Wellbery C. Diagnosis and treatment of endometriosis.Am Fam Physician. 1999; 60 (1767–8): 1753-1762PubMed Google Scholar). Treatment of infertility associated with endometriosis includes surgical methods (2Parazzini F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell’Endometriosi.Hum Reprod. 1999 May; 14: 1332-1334Crossref PubMed Scopus (342) Google Scholar, 3Tulandi T. al-Took S. Reproductive outcome after treatment of mild endometriosis with laparoscopic excision and electrocoagulation.Fertil Steril. 1998; 69: 229-231Abstract Full Text PDF PubMed Google Scholar), hormonal treatment (4Bianchi S. Busacca M. Agnoli B. Candiani M. Calia C. Vignali M. Effects of 3 months therapy with danazol after laparoscopic surgery for stage III/IV endometriosis a randomized study.Hum Reprod. 1999; 14: 1335-1337Crossref PubMed Scopus (86) Google Scholar, 5Audebert A. Medical treatment of endometriosis.Rev Prat. 1999; 49: 269-275PubMed Google Scholar), and assisted reproductive technologies (ART) (6Kodama H. Fukuda J. Karube H. Matsui T. Shimizu Y. Tanaka T. Benefit of in vitro fertilization treatment for endometriosis-associated infertility.Fertil Steril. 1996; 66: 974-979PubMed Scopus (45) Google Scholar).Surgery is commonly performed at the time of laparoscopic diagnosis and can remove all visible lesions (1Wellbery C. Diagnosis and treatment of endometriosis.Am Fam Physician. 1999; 60 (1767–8): 1753-1762PubMed Google Scholar, 7Chapron C. Fritel X. Dubuisson J.B. Fertility after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments.Hum Reprod. 1999; 14: 329-332Crossref PubMed Scopus (54) Google Scholar). Medical treatment of endometriosis is based on the fact that endometriotic lesions are hormone dependent (5Audebert A. Medical treatment of endometriosis.Rev Prat. 1999; 49: 269-275PubMed Google Scholar) and aims to decreases serum estrogen levels into the menopausal range. ART is another treatment option for women with endometriosis who want to become pregnant (6Kodama H. Fukuda J. Karube H. Matsui T. Shimizu Y. Tanaka T. Benefit of in vitro fertilization treatment for endometriosis-associated infertility.Fertil Steril. 1996; 66: 974-979PubMed Scopus (45) Google Scholar). Some investigators (8Al-Azemi M. Lopez Bernal A. Steele J. Gramsbergen I. Barlow D. Kennedy S. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis.Hum Reprod. 2000; 15: 72-75Crossref PubMed Scopus (118) Google Scholar, 9Bergendal A. Naffah S. Nagy C. Bergqvist A. Sjöblom P. Hillensjö T. Outcome of IVF in patients with endometriosis in comparison with tubal-factor infertility.J Assist Reprod Genet. 1998; 15: 530-534Crossref PubMed Scopus (89) Google Scholar, 10Geber S. Paraschos T. Atkinson G. Margara R. Winston R.M. Results of IVF in patients with endometriosis the severity of the disease does not affect outcome, or the incidence of miscarriage.Hum Reprod. 1995; 10: 1507-1511Crossref PubMed Scopus (112) Google Scholar, 11Olivennes F. Feldberg D. Liu H.C. Cohen J. Moy F. Rosenwaks Z. Endometriosis a stage by stage analysis—the role of in vitro fertilization.Fertil Steril. 1995; 64: 392-398Abstract Full Text PDF PubMed Google Scholar) have found that the pregnancy rate with IVF is similar in patients with endometriosis and patients with tubal factor infertility. Others, however, found a decreased number of retrieved oocytes and lower fertilization and implantation rates in patients with endometriosis (12Garrido N. Navarro J. Remohi J. Simon C. Pellicer A. Follicular hormonal environment and embryo quality in women with endometriosis.Hum Reprod Update. 2000; 6: 67-74Crossref PubMed Scopus (146) Google Scholar, 13Azem F. Lessing J.B. Geva E. Shahar A. Lerner-Geva L. Yovel I. et al.Patients with stages III and IV endometriosis have a poorer outcome of in vitro fertilization-embryo transfer than patients with tubal infertility.Fertil Steril. 1999; 72: 1107-1109Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar).We sought to compare results of ART (IVF and ICSI) in infertile patients with previous or current endometriosis with those in patients with tubal factor.Thirty-eight ART cycles were studied. Fifteen cycles were performed in 13 patients who presented with ovarian endometriomas diagnosed by ultrasonography or aspiration during ovum pick-up. The mean size of the endometriomas was 18 mm (range, 10–27 mm). The remaining 23 cycles (group B) were performed in 22 patients with endometriosis that had been diagnosed by laparotomy or laparoscopy (73% of whom had histologically proven endometriosis) 2 to 36 months (mean, 18 months) before ART was performed. All ICSI procedures were performed on patients in whom previous IVF had failed.All 35 patients had received either surgical or medical treatment in the past. None had clinical or ultrasonographic evidence of endometriosis at the time of the ART. No patient had any other infertility factor at the time of the ART. Controls (n = 83) were patients in whom tubal factor was the only cause of infertility. In all groups, we assessed the number and quality of the oocytes retrieved, the number of oocytes inseminated or microinjected, normal and abnormal fertilization rates, the number of embryos transferred, and the implantation, pregnancy, and abortion rates.Data are expressed as means (±SD) and relative frequencies. The Wilcoxon rank-sum test, the Mann-Whitney U test, and the χ2 test were performed. P<.05 was considered statistically significant.Demographic characteristics did not differ significantly among the three groups.The number of oocytes retrieved was lower in patients with endometriomas, but the implantation and pregnancy rates were higher compared with controls. The pregnancy rate in patients with past endometriosis was nonsignificantly higher. No other difference was found among the groups (Table 1). TABLE 1Results of ART in patients with endometriosis.VariableControls (n = 83)Women with current endometriosis (n = 15)P valueWomen with past endometriosis (n = 23)P valueOocytes retrieved10.35 ± 0.797.07 ± 1.49.048.48 ± 1.24.24Mature oocytes9.10 ± 0.716.60 ± 1.40.067.61 ± 1.23.29Immature oocytes1.25 ± 0.190.47 ± 0.17.190.87 ± 0.25.58Inseminated/injected oocytes7.93 ± 0.505.67 ± 0.65.076.39 ± 0.75.15Normal fertilization rate (%)70.11 ± 2.5569.20 ± 5.95.9979.39 ± 4.88.05Abnormal fertilization rate (%)6.71 ± 1.2412.47 ± 5.48.633.17 ± 1.68.13No. of embryos transferred3.74 ± 0.163.13 ± 0.03.123.74 ± 0.33.99No. of implantation rate (%)11.05 ± 2.5225.56 ± 7.42.0114.71 ± 4.51.24No. of pregnancies2199Pregnancy rate (%)25.360.0.0339.1.19No. of abortions722Abortion rate (%)8.413.3.558.7.97Note: Data with the plus/minus sign are the mean ± SD.Rinesi. Art and endometriosis. Fertil Steril 2002. Open table in a new tab Bergendal et al. (9Bergendal A. Naffah S. Nagy C. Bergqvist A. Sjöblom P. Hillensjö T. Outcome of IVF in patients with endometriosis in comparison with tubal-factor infertility.J Assist Reprod Genet. 1998; 15: 530-534Crossref PubMed Scopus (89) Google Scholar) and Geber et al. (10Geber S. Paraschos T. Atkinson G. Margara R. Winston R.M. Results of IVF in patients with endometriosis the severity of the disease does not affect outcome, or the incidence of miscarriage.Hum Reprod. 1995; 10: 1507-1511Crossref PubMed Scopus (112) Google Scholar) found that similar number of oocytes were retrieved in patients with endometriosis and those with tubal factor, whereas Minguez et al. (14Minguez Y. Rubio C. Bernal A. Gaitan P. Remohi J. Simon C. et al.The impact of endometriosis in couples undergoing intracytoplasmic sperm injection because of male infertility.Hum Reprod. 1997; 12: 2282-2285Crossref PubMed Scopus (44) Google Scholar) found that fewer oocytes were retrieved in patients with endometriosis. In addition, Minguez et al. (14Minguez Y. Rubio C. Bernal A. Gaitan P. Remohi J. Simon C. et al.The impact of endometriosis in couples undergoing intracytoplasmic sperm injection because of male infertility.Hum Reprod. 1997; 12: 2282-2285Crossref PubMed Scopus (44) Google Scholar) found no difference in the fertilization rate between patients with endometriosis treated with ICSI and patients with male factor infertility. Bergendal et al. (9Bergendal A. Naffah S. Nagy C. Bergqvist A. Sjöblom P. Hillensjö T. Outcome of IVF in patients with endometriosis in comparison with tubal-factor infertility.J Assist Reprod Genet. 1998; 15: 530-534Crossref PubMed Scopus (89) Google Scholar) found a lower fertilization rate in patients with endometriosis than in patients with tubal factor.Minguez et al. (14Minguez Y. Rubio C. Bernal A. Gaitan P. Remohi J. Simon C. et al.The impact of endometriosis in couples undergoing intracytoplasmic sperm injection because of male infertility.Hum Reprod. 1997; 12: 2282-2285Crossref PubMed Scopus (44) Google Scholar) found no difference in implantation rates in women with and without endometriosis. Garrido et al. (12Garrido N. Navarro J. Remohi J. Simon C. Pellicer A. Follicular hormonal environment and embryo quality in women with endometriosis.Hum Reprod Update. 2000; 6: 67-74Crossref PubMed Scopus (146) Google Scholar), however, showed a lower implantation rate in women with endometriosis, which was attributable to embryonic factors.Al-Azemi et al. (8Al-Azemi M. Lopez Bernal A. Steele J. Gramsbergen I. Barlow D. Kennedy S. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis.Hum Reprod. 2000; 15: 72-75Crossref PubMed Scopus (118) Google Scholar), Bergendal et al. (9Bergendal A. Naffah S. Nagy C. Bergqvist A. Sjöblom P. Hillensjö T. Outcome of IVF in patients with endometriosis in comparison with tubal-factor infertility.J Assist Reprod Genet. 1998; 15: 530-534Crossref PubMed Scopus (89) Google Scholar), Geber et al. (10Geber S. Paraschos T. Atkinson G. Margara R. Winston R.M. Results of IVF in patients with endometriosis the severity of the disease does not affect outcome, or the incidence of miscarriage.Hum Reprod. 1995; 10: 1507-1511Crossref PubMed Scopus (112) Google Scholar), and Olivennes et al. (11Olivennes F. Feldberg D. Liu H.C. Cohen J. Moy F. Rosenwaks Z. Endometriosis a stage by stage analysis—the role of in vitro fertilization.Fertil Steril. 1995; 64: 392-398Abstract Full Text PDF PubMed Google Scholar) found similar pregnancy rates in patients with endometriosis and women with tubal factor treated with ART. In contrast, Azem et al. (13Azem F. Lessing J.B. Geva E. Shahar A. Lerner-Geva L. Yovel I. et al.Patients with stages III and IV endometriosis have a poorer outcome of in vitro fertilization-embryo transfer than patients with tubal infertility.Fertil Steril. 1999; 72: 1107-1109Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar) found a lower pregnancy rate with ART in patients with moderate or severe endometriosis than in those with tubal factor. Tinkanen and Kujansuu (15Tinkanen H. Kujansuu E. In vitro fertilization in patients with ovarian endometriomas.Acta Obstet Gynecol Scand. 2000; 79: 119-122Crossref PubMed Scopus (92) Google Scholar) reported similar pregnancy rates in patients with endometriomas (average size, 3 cm) (n = 45) and those with previously treated endometriosis (n = 55) treated with IVF. Parazzini (2Parazzini F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell’Endometriosi.Hum Reprod. 1999 May; 14: 1332-1334Crossref PubMed Scopus (342) Google Scholar) studied the spontaneous pregnancy rate over 1 year in 96 patients with minimal or mild endometriosis, of whom 51 received surgical treatment and 45 received no treatment. Pregnancy rates did not differ between the groups (23.5% vs. 28.9%).In our study, the abortion rate did not differ among the groups. This finding agrees with observations in other studies (9Bergendal A. Naffah S. Nagy C. Bergqvist A. Sjöblom P. Hillensjö T. Outcome of IVF in patients with endometriosis in comparison with tubal-factor infertility.J Assist Reprod Genet. 1998; 15: 530-534Crossref PubMed Scopus (89) Google Scholar, 10Geber S. Paraschos T. Atkinson G. Margara R. Winston R.M. Results of IVF in patients with endometriosis the severity of the disease does not affect outcome, or the incidence of miscarriage.Hum Reprod. 1995; 10: 1507-1511Crossref PubMed Scopus (112) Google Scholar).In most cases, surgery is the initial treatment of endometriosis. However, in women with infertility, it is not certain whether surgical treatment is more effective than medical treatment or no treatment at all (1Wellbery C. Diagnosis and treatment of endometriosis.Am Fam Physician. 1999; 60 (1767–8): 1753-1762PubMed Google Scholar, 14Minguez Y. Rubio C. Bernal A. Gaitan P. Remohi J. Simon C. et al.The impact of endometriosis in couples undergoing intracytoplasmic sperm injection because of male infertility.Hum Reprod. 1997; 12: 2282-2285Crossref PubMed Scopus (44) Google Scholar, 16Fabre V. Camus M. Devroey P. Endometriosis and sterility.Rev Prat. 1999; 49: 279-281PubMed Google Scholar, 17Chapron C. Dubuisson J.B. Fernandez B. Dousset B. Surgical treatment of endometriosis.Rev Prat. 1999 Feb 1; 49: 276-278PubMed Google Scholar). Surgical treatment may result in diminished ovarian reserve and high risk for recurrence (8%–11%) during the first year after treatment (15Tinkanen H. Kujansuu E. In vitro fertilization in patients with ovarian endometriomas.Acta Obstet Gynecol Scand. 2000; 79: 119-122Crossref PubMed Scopus (92) Google Scholar). Wellbery (1Wellbery C. Diagnosis and treatment of endometriosis.Am Fam Physician. 1999; 60 (1767–8): 1753-1762PubMed Google Scholar), Chapron et al. (7Chapron C. Fritel X. Dubuisson J.B. Fertility after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments.Hum Reprod. 1999; 14: 329-332Crossref PubMed Scopus (54) Google Scholar), and Fabre et al. (16Fabre V. Camus M. Devroey P. Endometriosis and sterility.Rev Prat. 1999; 49: 279-281PubMed Google Scholar) found that medical treatment does not resolve adhesions, endometriomas, and infertility. Pouly et al. (18Pouly J.L. Drolet J. Canis M. Boughazine S. Mage G. Bruhat M.A. et al.Laparoscopic treatment of symptomatic endometriosis.Hum Reprod. 1996 Nov; 11: 67-88Crossref PubMed Scopus (31) Google Scholar) showed a pregnancy rate of 50% with laparoscopic treatment. A multicenter study by Marcoux et al. (19Marcoux S. Maheux R. Berube S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group.N Engl J Med. 1997; 337: 217-222Crossref PubMed Scopus (835) Google Scholar) found that laparoscopic resection or ablation of minimal and mild endometriosis enhances fecundity in infertile women. Pagidas et al. (20Pagidas K. Falcone T. Hemmings R. Miron P. Comparison of reoperation for moderate (stage III) and severe (stage IV) endometriosis-related infertility with in vitro fertilization-embryo transfer.Fertil Steril. 1996; 65: 791-795Abstract Full Text PDF PubMed Scopus (125) Google Scholar) suggested that the ART should be an option for treatment of patients with moderate and severe endometriosis who have already had surgical treatment. Ledger (21Ledger W.L. Endometriosis and infertility an integrated approach.Int J Gynaecol Obstet. 1999; 64: 33-40Abstract Full Text Full Text PDF Google Scholar) showed good results with ART in patients with minimal or mild endometriosis after laparoscopic treatment.In summary, we found that ART can be considered a valid alternative to treat infertility associated with present or previously treated endometriosis. The type of ART used depends on factors such as patient age, duration of infertility, and previous treatments. Endometriosis is a progressive disease that causes dyspareunia, dysmenorrhea, low back pain, and infertility (1Wellbery C. Diagnosis and treatment of endometriosis.Am Fam Physician. 1999; 60 (1767–8): 1753-1762PubMed Google Scholar). Treatment of infertility associated with endometriosis includes surgical methods (2Parazzini F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell’Endometriosi.Hum Reprod. 1999 May; 14: 1332-1334Crossref PubMed Scopus (342) Google Scholar, 3Tulandi T. al-Took S. Reproductive outcome after treatment of mild endometriosis with laparoscopic excision and electrocoagulation.Fertil Steril. 1998; 69: 229-231Abstract Full Text PDF PubMed Google Scholar), hormonal treatment (4Bianchi S. Busacca M. Agnoli B. Candiani M. Calia C. Vignali M. Effects of 3 months therapy with danazol after laparoscopic surgery for stage III/IV endometriosis a randomized study.Hum Reprod. 1999; 14: 1335-1337Crossref PubMed Scopus (86) Google Scholar, 5Audebert A. Medical treatment of endometriosis.Rev Prat. 1999; 49: 269-275PubMed Google Scholar), and assisted reproductive technologies (ART) (6Kodama H. Fukuda J. Karube H. Matsui T. Shimizu Y. Tanaka T. Benefit of in vitro fertilization treatment for endometriosis-associated infertility.Fertil Steril. 1996; 66: 974-979PubMed Scopus (45) Google Scholar). Surgery is commonly performed at the time of laparoscopic diagnosis and can remove all visible lesions (1Wellbery C. Diagnosis and treatment of endometriosis.Am Fam Physician. 1999; 60 (1767–8): 1753-1762PubMed Google Scholar, 7Chapron C. Fritel X. Dubuisson J.B. Fertility after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments.Hum Reprod. 1999; 14: 329-332Crossref PubMed Scopus (54) Google Scholar). Medical treatment of endometriosis is based on the fact that endometriotic lesions are hormone dependent (5Audebert A. Medical treatment of endometriosis.Rev Prat. 1999; 49: 269-275PubMed Google Scholar) and aims to decreases serum estrogen levels into the menopausal range. ART is another treatment option for women with endometriosis who want to become pregnant (6Kodama H. Fukuda J. Karube H. Matsui T. Shimizu Y. Tanaka T. Benefit of in vitro fertilization treatment for endometriosis-associated infertility.Fertil Steril. 1996; 66: 974-979PubMed Scopus (45) Google Scholar). Some investigators (8Al-Azemi M. Lopez Bernal A. Steele J. Gramsbergen I. Barlow D. Kennedy S. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis.Hum Reprod. 2000; 15: 72-75Crossref PubMed Scopus (118) Google Scholar, 9Bergendal A. Naffah S. Nagy C. Bergqvist A. Sjöblom P. Hillensjö T. Outcome of IVF in patients with endometriosis in comparison with tubal-factor infertility.J Assist Reprod Genet. 1998; 15: 530-534Crossref PubMed Scopus (89) Google Scholar, 10Geber S. Paraschos T. Atkinson G. Margara R. Winston R.M. Results of IVF in patients with endometriosis the severity of the disease does not affect outcome, or the incidence of miscarriage.Hum Reprod. 1995; 10: 1507-1511Crossref PubMed Scopus (112) Google Scholar, 11Olivennes F. Feldberg D. Liu H.C. Cohen J. Moy F. Rosenwaks Z. Endometriosis a stage by stage analysis—the role of in vitro fertilization.Fertil Steril. 1995; 64: 392-398Abstract Full Text PDF PubMed Google Scholar) have found that the pregnancy rate with IVF is similar in patients with endometriosis and patients with tubal factor infertility. Others, however, found a decreased number of retrieved oocytes and lower fertilization and implantation rates in patients with endometriosis (12Garrido N. Navarro J. Remohi J. Simon C. Pellicer A. Follicular hormonal environment and embryo quality in women with endometriosis.Hum Reprod Update. 2000; 6: 67-74Crossref PubMed Scopus (146) Google Scholar, 13Azem F. Lessing J.B. Geva E. Shahar A. Lerner-Geva L. Yovel I. et al.Patients with stages III and IV endometriosis have a poorer outcome of in vitro fertilization-embryo transfer than patients with tubal infertility.Fertil Steril. 1999; 72: 1107-1109Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar). We sought to compare results of ART (IVF and ICSI) in infertile patients with previous or current endometriosis with those in patients with tubal factor. Thirty-eight ART cycles were studied. Fifteen cycles were performed in 13 patients who presented with ovarian endometriomas diagnosed by ultrasonography or aspiration during ovum pick-up. The mean size of the endometriomas was 18 mm (range, 10–27 mm). The remaining 23 cycles (group B) were performed in 22 patients with endometriosis that had been diagnosed by laparotomy or laparoscopy (73% of whom had histologically proven endometriosis) 2 to 36 months (mean, 18 months) before ART was performed. All ICSI procedures were performed on patients in whom previous IVF had failed. All 35 patients had received either surgical or medical treatment in the past. None had clinical or ultrasonographic evidence of endometriosis at the time of the ART. No patient had any other infertility factor at the time of the ART. Controls (n = 83) were patients in whom tubal factor was the only cause of infertility. In all groups, we assessed the number and quality of the oocytes retrieved, the number of oocytes inseminated or microinjected, normal and abnormal fertilization rates, the number of embryos transferred, and the implantation, pregnancy, and abortion rates. Data are expressed as means (±SD) and relative frequencies. The Wilcoxon rank-sum test, the Mann-Whitney U test, and the χ2 test were performed. P<.05 was considered statistically significant. Demographic characteristics did not differ significantly among the three groups. The number of oocytes retrieved was lower in patients with endometriomas, but the implantation and pregnancy rates were higher compared with controls. The pregnancy rate in patients with past endometriosis was nonsignificantly higher. No other difference was found among the groups (Table 1). Note: Data with the plus/minus sign are the mean ± SD. Rinesi. Art and endometriosis. Fertil Steril 2002. Bergendal et al. (9Bergendal A. Naffah S. Nagy C. Bergqvist A. Sjöblom P. Hillensjö T. Outcome of IVF in patients with endometriosis in comparison with tubal-factor infertility.J Assist Reprod Genet. 1998; 15: 530-534Crossref PubMed Scopus (89) Google Scholar) and Geber et al. (10Geber S. Paraschos T. Atkinson G. Margara R. Winston R.M. Results of IVF in patients with endometriosis the severity of the disease does not affect outcome, or the incidence of miscarriage.Hum Reprod. 1995; 10: 1507-1511Crossref PubMed Scopus (112) Google Scholar) found that similar number of oocytes were retrieved in patients with endometriosis and those with tubal factor, whereas Minguez et al. (14Minguez Y. Rubio C. Bernal A. Gaitan P. Remohi J. Simon C. et al.The impact of endometriosis in couples undergoing intracytoplasmic sperm injection because of male infertility.Hum Reprod. 1997; 12: 2282-2285Crossref PubMed Scopus (44) Google Scholar) found that fewer oocytes were retrieved in patients with endometriosis. In addition, Minguez et al. (14Minguez Y. Rubio C. Bernal A. Gaitan P. Remohi J. Simon C. et al.The impact of endometriosis in couples undergoing intracytoplasmic sperm injection because of male infertility.Hum Reprod. 1997; 12: 2282-2285Crossref PubMed Scopus (44) Google Scholar) found no difference in the fertilization rate between patients with endometriosis treated with ICSI and patients with male factor infertility. Bergendal et al. (9Bergendal A. Naffah S. Nagy C. Bergqvist A. Sjöblom P. Hillensjö T. Outcome of IVF in patients with endometriosis in comparison with tubal-factor infertility.J Assist Reprod Genet. 1998; 15: 530-534Crossref PubMed Scopus (89) Google Scholar) found a lower fertilization rate in patients with endometriosis than in patients with tubal factor. Minguez et al. (14Minguez Y. Rubio C. Bernal A. Gaitan P. Remohi J. Simon C. et al.The impact of endometriosis in couples undergoing intracytoplasmic sperm injection because of male infertility.Hum Reprod. 1997; 12: 2282-2285Crossref PubMed Scopus (44) Google Scholar) found no difference in implantation rates in women with and without endometriosis. Garrido et al. (12Garrido N. Navarro J. Remohi J. Simon C. Pellicer A. Follicular hormonal environment and embryo quality in women with endometriosis.Hum Reprod Update. 2000; 6: 67-74Crossref PubMed Scopus (146) Google Scholar), however, showed a lower implantation rate in women with endometriosis, which was attributable to embryonic factors. Al-Azemi et al. (8Al-Azemi M. Lopez Bernal A. Steele J. Gramsbergen I. Barlow D. Kennedy S. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis.Hum Reprod. 2000; 15: 72-75Crossref PubMed Scopus (118) Google Scholar), Bergendal et al. (9Bergendal A. Naffah S. Nagy C. Bergqvist A. Sjöblom P. Hillensjö T. Outcome of IVF in patients with endometriosis in comparison with tubal-factor infertility.J Assist Reprod Genet. 1998; 15: 530-534Crossref PubMed Scopus (89) Google Scholar), Geber et al. (10Geber S. Paraschos T. Atkinson G. Margara R. Winston R.M. Results of IVF in patients with endometriosis the severity of the disease does not affect outcome, or the incidence of miscarriage.Hum Reprod. 1995; 10: 1507-1511Crossref PubMed Scopus (112) Google Scholar), and Olivennes et al. (11Olivennes F. Feldberg D. Liu H.C. Cohen J. Moy F. Rosenwaks Z. Endometriosis a stage by stage analysis—the role of in vitro fertilization.Fertil Steril. 1995; 64: 392-398Abstract Full Text PDF PubMed Google Scholar) found similar pregnancy rates in patients with endometriosis and women with tubal factor treated with ART. In contrast, Azem et al. (13Azem F. Lessing J.B. Geva E. Shahar A. Lerner-Geva L. Yovel I. et al.Patients with stages III and IV endometriosis have a poorer outcome of in vitro fertilization-embryo transfer than patients with tubal infertility.Fertil Steril. 1999; 72: 1107-1109Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar) found a lower pregnancy rate with ART in patients with moderate or severe endometriosis than in those with tubal factor. Tinkanen and Kujansuu (15Tinkanen H. Kujansuu E. In vitro fertilization in patients with ovarian endometriomas.Acta Obstet Gynecol Scand. 2000; 79: 119-122Crossref PubMed Scopus (92) Google Scholar) reported similar pregnancy rates in patients with endometriomas (average size, 3 cm) (n = 45) and those with previously treated endometriosis (n = 55) treated with IVF. Parazzini (2Parazzini F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell’Endometriosi.Hum Reprod. 1999 May; 14: 1332-1334Crossref PubMed Scopus (342) Google Scholar) studied the spontaneous pregnancy rate over 1 year in 96 patients with minimal or mild endometriosis, of whom 51 received surgical treatment and 45 received no treatment. Pregnancy rates did not differ between the groups (23.5% vs. 28.9%). In our study, the abortion rate did not differ among the groups. This finding agrees with observations in other studies (9Bergendal A. Naffah S. Nagy C. Bergqvist A. Sjöblom P. Hillensjö T. Outcome of IVF in patients with endometriosis in comparison with tubal-factor infertility.J Assist Reprod Genet. 1998; 15: 530-534Crossref PubMed Scopus (89) Google Scholar, 10Geber S. Paraschos T. Atkinson G. Margara R. Winston R.M. Results of IVF in patients with endometriosis the severity of the disease does not affect outcome, or the incidence of miscarriage.Hum Reprod. 1995; 10: 1507-1511Crossref PubMed Scopus (112) Google Scholar). In most cases, surgery is the initial treatment of endometriosis. However, in women with infertility, it is not certain whether surgical treatment is more effective than medical treatment or no treatment at all (1Wellbery C. Diagnosis and treatment of endometriosis.Am Fam Physician. 1999; 60 (1767–8): 1753-1762PubMed Google Scholar, 14Minguez Y. Rubio C. Bernal A. Gaitan P. Remohi J. Simon C. et al.The impact of endometriosis in couples undergoing intracytoplasmic sperm injection because of male infertility.Hum Reprod. 1997; 12: 2282-2285Crossref PubMed Scopus (44) Google Scholar, 16Fabre V. Camus M. Devroey P. Endometriosis and sterility.Rev Prat. 1999; 49: 279-281PubMed Google Scholar, 17Chapron C. Dubuisson J.B. Fernandez B. Dousset B. Surgical treatment of endometriosis.Rev Prat. 1999 Feb 1; 49: 276-278PubMed Google Scholar). Surgical treatment may result in diminished ovarian reserve and high risk for recurrence (8%–11%) during the first year after treatment (15Tinkanen H. Kujansuu E. In vitro fertilization in patients with ovarian endometriomas.Acta Obstet Gynecol Scand. 2000; 79: 119-122Crossref PubMed Scopus (92) Google Scholar). Wellbery (1Wellbery C. Diagnosis and treatment of endometriosis.Am Fam Physician. 1999; 60 (1767–8): 1753-1762PubMed Google Scholar), Chapron et al. (7Chapron C. Fritel X. Dubuisson J.B. Fertility after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments.Hum Reprod. 1999; 14: 329-332Crossref PubMed Scopus (54) Google Scholar), and Fabre et al. (16Fabre V. Camus M. Devroey P. Endometriosis and sterility.Rev Prat. 1999; 49: 279-281PubMed Google Scholar) found that medical treatment does not resolve adhesions, endometriomas, and infertility. Pouly et al. (18Pouly J.L. Drolet J. Canis M. Boughazine S. Mage G. Bruhat M.A. et al.Laparoscopic treatment of symptomatic endometriosis.Hum Reprod. 1996 Nov; 11: 67-88Crossref PubMed Scopus (31) Google Scholar) showed a pregnancy rate of 50% with laparoscopic treatment. A multicenter study by Marcoux et al. (19Marcoux S. Maheux R. Berube S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group.N Engl J Med. 1997; 337: 217-222Crossref PubMed Scopus (835) Google Scholar) found that laparoscopic resection or ablation of minimal and mild endometriosis enhances fecundity in infertile women. Pagidas et al. (20Pagidas K. Falcone T. Hemmings R. Miron P. Comparison of reoperation for moderate (stage III) and severe (stage IV) endometriosis-related infertility with in vitro fertilization-embryo transfer.Fertil Steril. 1996; 65: 791-795Abstract Full Text PDF PubMed Scopus (125) Google Scholar) suggested that the ART should be an option for treatment of patients with moderate and severe endometriosis who have already had surgical treatment. Ledger (21Ledger W.L. Endometriosis and infertility an integrated approach.Int J Gynaecol Obstet. 1999; 64: 33-40Abstract Full Text Full Text PDF Google Scholar) showed good results with ART in patients with minimal or mild endometriosis after laparoscopic treatment. In summary, we found that ART can be considered a valid alternative to treat infertility associated with present or previously treated endometriosis. The type of ART used depends on factors such as patient age, duration of infertility, and previous treatments. The authors thank Dr. Carlos Sueldo for editorial assistance." @default.
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