Purpose of reviewTo discuss optimal management of an assisted reproductive technology (ART) cycle in women with endometriosis. Recent findingsNew studies involving euploid embryo transfers provide more insight on the etiology of endometriosisassociated infertility. Oocyte competence to reach live birth seems unlikely to be affected by the disease. Routine medical or surgical treatment prior to an ART cycle does not appear beneficial. Short gonadotropin releasing hormone (GnRH) antagonist or progestin primed ovarian stimulation protocols seem to be proper first choices, depending on the intention for a fresh embryo transfer. Low-quality evidence supports frozen thawed over fresh embryo transfer. Ovarian stimulation for ART does not seem to be associated with symptom progression or recurrence.

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Objective: To evaluate of the effectiveness of low-dose (LD) vaginal misoprostol administration, where dose adjustment was made by taking into account the gestational week and cesarean section (C/S) history in termination of pregnacy (ToP). Design: Retrospective observational cohort study. Setting: A single tertiary center Population: 563 patients who opted ToP under 34 weeks of gestation. Methods: Outcomes were ascertained by health record review and compared between subgroups according to gestational weeks and previous C/S history. Main Outcome Measures: Total misoprostol administration time, total labor time, total misoprostol dose, >1 ToP method, uterin rupture, uterine atony Results: 63% (357) of 563 cases with pregnancy termination were below the 24th gestational week (Gx). The remaining 206 cases (Gy) (37%) were between 24 and 34 weeks of gestation. The rate of C/S history was statistically significantly higher in Gx (p=0.030). While a single termination method below 24 weeks was sufficient in 94% of cases, this rate remained at 86% in Gy (p=0.002). There was no difference in the complication rate between the groups according to the gestational week or the presence of a prior C/S (p>0.05). Concusions: The present regimen is an effective method with low maternal morbidity and high success without increasing the total treatment time. Especially in patients with a history of C/S where the ‘experience of ToP with misoprostol’ have relatively high risk , and in all ToPs below 34 weeks, achieving a high birth rate without increasing the uterine rupture rate suggests that it is a safe approach.

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