The effect of endometriosis on the fertility of women

Abstract

Endometriosis is defined by the presence of ectopic endometrial tissue outside the uterus, frequently located on pelvic organs such as the fallopian tubes and ovaries, and occasionally beyond the pelvic region. This condition manifests as dysmenorrhea, chronic pelvic pain, dyspareunia, and subfertility. Despite extensive research, the etiology and pathogenesis of endometriosis remain unclear, with laparoscopy being the definitive diagnostic method. The association between endometriosis and infertility has been extensively debated. Endometriosis can impair fertility by disrupting embryo implantation, altering hormone levels, and compromising oocyte quality. This literature review aims to examine the effects of endometriosis on female fertility. The review encompasses documents from clinical trials with control groups involving 196 to 22,416 reproductive-age participants (25-42 years), and case studies published over the past thirty-seven years from various regions (USA, Australia, Turkey, Africa, and Europe. Reputable databases such as BMJ, NEJM, Elsevier, AJR, Medline, and PubMed were utilized, with references compiled in the bibliography. A risk-benefit analysis indicates that up to 50% of women with endometriosis experience infertility. Consensus on treatment options remains elusive. The relationship between endometriosis and infertility is supported by studies of both fertile and infertile women, animal studies, donor sperm studies, and in vitro fertilization outcomes. Diagnostic methodologies based on endometrial changes are providing insights into potential mechanisms of infertility, especially in women with milder disease. However, clinical management of endometriosis-related infertility has not shown conclusive success beyond in vitro fertilization.