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32 - Endometriosis-Associated Infertility

from PART II - INFERTILITY EVALUATION AND TREATMENT

Published online by Cambridge University Press:  04 August 2010

By
Cem S. Atabekoglu  and
Aydin Arici
Edited by
Botros R. M. B. Rizk ,
Juan A. Garcia-Velasco ,
Hassan N. Sallam  and
Antonis Makrigiannakis
Botros R. M. B. Rizk
Affiliation:
University of South Alabama
Juan A. Garcia-Velasco
Affiliation:
Rey Juan Carlos University School of Medicine,
Hassan N. Sallam
Affiliation:
University of Alexandria School of Medicine
Antonis Makrigiannakis
Affiliation:
University of Crete
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Summary

INTRODUCTION

Endometriosis is a common pathological process that mostly occurs in the female pelvis. Despite a long history of clinical experience and experimental research, the pathogenesis and management of endometriosis still have a lot of uncertainty. Endometriosis is one of the most common gynecologic diseases affecting fertility potential of women. The prevalence of endometriosis in infertile women ranges from 20 to 55 percent, as compared with 2–5 percent of women undergoing tubal ligation (1, 2). This correlation has led many investigators and clinicians to the assumption that there is a causal relationship between these two entities. There is still no definite answer to the question concerning why patients with endometriosis have subfertility. Several explanations have been proposed for the etiology of infertility of patients with endometriosis. The most straightforward one is anatomical distortion present in advanced disease. However, affected women who have functional, patent tubes, with no anatomic distortion, may also be associated with infertility. Several others possibilities have been suggested, related to immunologic defects and altered characteristics of peritoneal fluid involving cytokines and macrophages, which may affect fertility by means of altered folliculogenesis, ovulatory dysfunction, reduced preovulatory steroidogenesis of granulosa cells, sperm phagocytosis, and impaired fertilization (3).

We do not expect to clarify these enigmas completely in this chapter, but we will try to illustrate different opinions regarding the pathophysiology and management of endometriosis-associated infertility according to the current knowledge.

Keywords

clomiphene citrateendometriosisGnRH agonistsin vitro fertilizationintracytoplasmic sperm injectionintrauterine inseminationlaparoscopic surgeryinfertilitypelvic inflammation
Type
Chapter
Information
Infertility and Assisted Reproduction , pp. 302 - 308
Publisher: Cambridge University Press
Print publication year: 2008

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