Finding the balance between surgery and Medically Assisted Reproduction in women with deep endometriosis.

Finding the balance between surgery and Medically Assisted Reproduction in women with deep endometriosis. Minerva Ginecol. 2016 Apr 21; Authors: Cohen J, Ballester M, Selleret L, Mathieu D'Argent E, Antoine JM, Chabbert-Buffet N, Darai E Abstract Deep infiltrating endometriosis (DIE) affects several anatomical locations including the bladder, torus uterinum, uterosacral ligament, rectovaginal septum and bowel. It is the most debilitating form of endometriosis and causes severe pain, digestive and urinary symptoms as well as infertility. Faced with an infertile woman suffering from DIE, the dilemma is when to opt for first-line IVF treatment or surgery. In the absence of high level of evidence from randomized studies, several factors should be taken into account in the decision-making process. The main criterion is whether the patient wants IVF treatment or not. Secondly, while previous reports have demonstrated the positive impact of surgery on pregnancy, they also underline the risk of severe complications requiring management in expert centers. Despite the availability of predictive models or scoring systems, the decision mainly boils down to the couple's characteristics. It seems logical to propose first-line IVF when spontaneous fertility is not possible due to associated male infertility or tubal obstruction; for women aged ≥ 35 years; or in women with diminished ovarian reserve. Conversely, first-line surgery could be the bes...
Source: Minerva Ginecologica - Category: OBGYN Tags: Minerva Ginecol Source Type: research