Preservación de fertilidad en endometriosis: estado actual de conocimiento y papel del sistema público de salud

Abstract

Endometriosis is a prevalent and polymorphic disease in which fertility may be impaired. Some patients may have an ovarian reverse loss, compromising their reproductive future, even with assisted reproduction techniques.

Early diagnosis and accurate follow-up are essential to avoid endometriosis consequences, not only on fertility, but also on quality of life. Professionals from different fields need an adequate training and collaboration with other specialists. For integrated fertility preservation, measures for preventing recurrence (mainly oral contraception), individualised surgery indications, ovarian tissue conservative surgical techniques and, in selected cases, oocyte vitrification should be considered.

Although patients must be informed of the benefits of pregnancy at a young age, this is often a non-realistic option. Oocyte vitrification is an effective alternative to postpone maternity, but its efficacy is related to the age of the woman and to the quantity and quality of the oocytes obtained. Publications related to preservation in endometriosis are scarce, and extrapolating data from other kinds of patients, although inexact, is the only available reference.

Oocyte vitrification in public health systems should have some cost-benefit conditions. It should be offered in cases with a real risk of ovarian reserve loss, but when there are adequate conditions to achieve an ovarian stimulation response to be able to obtain a sufficient number of oocytes. Patients with endometriosis will be candidates for vitrification if they fulfil two conditions: 1) bilateral endometrioma of more than 4 cm, or post-surgical recurrence of endometriosis, and 2)- age ≤ 35 years and ovarian reserve markers excluding low ovarian reserve (AMH > 1 ng/ml; antral follicle count > 5; FSH > 10 mg/ml). As 10 vitrified oocytes should be considered a sufficient number, a maximum of 2 cycles will be offered to reach this number. Follow-up of these cases will allow an evaluation of the efficacy and efficiency of this policy to be made in the future.