[Results of IVF in women with endometriosis].J Gynecol Obstet Biol Reprod (Paris) 2003; 32(8 Pt 2):S45-7JG
When associated with infertility, endometriosis often requires in vitro fertilization (IVF). The need of IVF instead of other Assisted Reproductive Technologies is correlated with the severity of the lesions and associated tubal pathology. Results of IVF (in terms of pregnancy rates), are influenced by the existence of endometriosis, but this influence remains controversial, and focused on three possible points: poor ovarian reserve (and ovarian response), poor quality of oocytes and embryos, poor implantation. It seems that mild and moderate endometriosis (I-II American Fertility Society score) has few deleterious effect on ovarian reserve, ovarian response, and pregnancy rates. All these parameters are decreased by the existence of severe endometriosis (III-IV AFS). Its surgical treatment appears to improve the results of IVF, notably in women under 35. But iterative surgery of endometriomas might be deleterious for ovarian function. Previous treatment by Gn-RH agonists also improves the outcome of IVF, whereas ICSI does not modify either the biological parameters, nor the pregnancy rates. Ovarian hyperstimulation in women with endometriosis might increase the severity of the lesions and the risk of complications: the use of unstimulated cycle (n-IVF) in young patients with normal ovarian reserve might be interesting.