Fertility Preservation in Women with Endometriosis : It is About Time We Talk About it !

Endometriosis is a common benign disease that affects young women and carries a significant risk to the reproductive organs. Studies have shown that endometriosis is associated with diminished ovarian reserve and worse prognosis in assisted reproductive technology treatments. Surgical treatment aims to remove the disease while maintaining reproductive potential with minimal damage to the reproductive organs. The authors reviewed the published literature regarding fertility preservation in endometriosis, focussing on patient selection criteria, available treatment options, and follow-up. The goal of this study was to find evidence to answer the following clinical questions: how should women Carneiro et al. face the important issue of how to preserve fertility in women with endometriosis: a condition that affects >10% of women in reproductive age. Besides reviewing the pathophysiological mechanisms related to endometriosis and the consequential infertility that often develops in these women, the review analyses data in the literature concerning the safety and reproductive repercussions of surgical treatment. Recent studies have indeed questioned surgical treatment which can further compromise the fertility of these women. The article indicates recommendations for physicians to follow to manage patients with endometriosis, starting from ovarian reserve evaluation, by measuring appropriate hormones, such as folliclestimulating hormone and anti-Müllerian hormone, considering age, antral follicular count, ovarian volume, and other aspects. The article also considers the options available to preserve fertility in these patients, such as oocyte, ovarian tissue and even embryo preservation. Overall, the review represents a complete guide for physicians and gynaecologists who face this problem every day. Prof Elisabetta Baldi University of Florence, Italy