The role of fertility preservation in patients with endometriosis

Abstract

Patients affected with severe endometriosis are at significant risk for ovarian tissue damage, which may lead to infertility, reduced response to ovarian stimulation, and occasionally, premature ovarian failure. The risk for a compromised ovarian reserve in young patients is especially high following repeated surgical intervention and in the presence of bilateral endometriomas. In many cases, enhanced loss of ovarian reserve may also result from the damaging effect of the pathologic process on follicle reservoir even without surgical interventions. Women diagnosed with severe endometriosis and those designated for extensive ovarian surgical intervention are frequently not planning to conceive. In light of recent advances in fertility preservation techniques (FPT), such as oocytes and ovarian tissue freezing, as well as their increasing success rates, we critically evaluate the options for FPT in patients suffering from endometriosis. Personalized counseling should be offered to all patients with endometriosis taking into account age, extent of ovarian involvement, current ovarian reserve, previous and impending surgeries for endometriosis, along with current success rates and possible risks associated with FPT.

Challenges of fertility preservation in non‐oncological diseases

“…Endometrioma surgery seems to be more deleterious to the ovarian reserve than surgery for the other types of benign cysts . Moreover, endometriosis has a direct negative effect on the ovarian reserve, as shown by the lower AMH levels and antral follicle count reductions observed in these women . This might be explained by ovarian fibrosis, observed in 55% of the ovaries with endometriomas, and by the toxic effects of oxidative stress on ovarian follicles .…”

“…53 Moreover, endometriosis has a direct negative effect on the ovarian reserve, as shown by the lower AMH levels and antral follicle count reductions observed in these women. 54 This might be explained by ovarian fibrosis, observed in 55% of the ovaries with endometriomas, and by the toxic effects of oxidative stress on ovarian follicles. 55 Considering these effects on ovarian reserve and the high risk of recurrence, fertility preservation options should be discussed in young women with these conditions.…”

Mid-life fertility

“…The decline in fertility may get accelerated in certain diseases because of the disease itself or the therapy required or both, e.g. endometriosis, leiomyoma, genital cancers, genital tuberculosis, chemotherapy and radiotherapy 18 19 20 21 .…”

Management of Endometriosis in the Infertile Patient

“…Not surprisingly, endometriosis is now more and more claimed to be an indication for fertility preservation. [53][54][55][56][57][58] On the other hand, cautious is warranted. The several available opinion papers contrast with the few and inconclusive clinical data (►Table 1).…”