Finding the balance between surgery and medically-assisted reproduction in women with deep infiltrating endometriosis

Cohen J, Jonathan Cohen, Ballester M, Marta Ballester, Marcos Ballester, Lise Selleret, Selleret L, Emmanuelle Mathieu d'Argent, Mathieu d'Argent E, Jean M Antoine, Antoine JM, Nathalie Chabbert-Buffet, Nathalie Chabbert‐Buffet, Chabbert-Buffet N, Émile Daraï, Emile Darai, Darai E
Minerva ginecologica · 2016 · vol. 68(6) , pp. 642–52 · PMID:27098393 · W2415750699
Review OA: closed CC0 ⤵ 9 in-corpus citations
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This paper discusses the decision-making process for infertile women with deep infiltrating endometriosis, balancing IVF versus surgery based on patient preference, age, ovarian reserve, and other factors, though randomized trials are needed.

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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 whether to opt for first-line IVF treatment or for 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 in-vitro fertilization (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 best option for women without these characteristics. However, this strategy is mainly based on low-level of evidence underlining the requiring of randomized trials.

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Condition tags

endometriosisdie_deep_infiltratinginfertility

MeSH descriptors

Endometriosis Fertilization in Vitro Infertility, Female Decision Making Decision Making Endometriosis Endometriosis Endometriosis Endometriosis Female Female Fertilization in Vitro Fertilization in Vitro Humans Humans Infertility, Female Infertility, Female Infertility, Male Infertility, Male Male

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

Cited by (9)

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License: CC0 · commercial use OK