Treatment of endometriosis-related infertility

  Endometriosis (endometriosis) is most commonly manifested by chronic pelvic pain and infertility. Endometriosis associated with infertility accounts for about 50% of cases, due to a combination of anatomical disruption, immune, endocrine and psychosomatic factors; and more than 30% of infertility is caused by endometriosis, so the two are closely related. The current treatment for endo-related infertility mainly includes pharmacological treatment, laparoscopic surgery and assisted reproductive technology.  In patients with endohetero infertility who have been thoroughly examined, other infertility factors have been excluded, and drug therapy alone is ineffective, laparoscopic examination is feasible to assess the type and stage of endohetero lesions, and intraoperative attention should be paid to separating adhesions, protecting normal ovarian tissue, understanding tubal patency and understanding the uterine cavity. Postoperative medication should be selected according to the patient’s condition and fertility desire. Patients with stage I and II endometriosis who have patent fallopian tubes may be treated without additional medication and encouraged to have a pregnancy as soon as possible. Most pregnancies occur within 1 year after surgery, especially 6 months after surgery, so the timing should be grasped. For patients with endometriosis III or IV, if the endo-foci are not easily cleared, or if pregnancy is not needed for other reasons, postoperative treatment should be supplemented with drugs to clear the residual lesions and prevent recurrence.  For those with high-risk factors (age ≥ 35 years, adhesions in the fallopian tubes with low functional score, infertility duration ≥ 3 years, especially primary infertility, moderate or severe endoheterosis with pelvic adhesions and incomplete removal of lesions), assisted reproductive techniques should be actively used to help pregnancy: mainly including controlled superovulation and/or artificial insemination, in vitro fertilization-embryo transfer (IVF-ET) The choice should be made according to the patient’s specific situation.  Controlled ovulation and/or IUI are mainly used for patients with mild or moderate endometriosis, male factor (mild oligospermia, weak sperm, etc.), cervical factor, and patients with unexplained infertility. The pregnancy rate of a single cycle of IUI is about 15%. If pregnancy is still unsuccessful after 3-4 treatments, the mode of pregnancy assistance should be adjusted.  2. IVF-ET is mainly used for infertility patients with severe endometriosis or failure of other treatments (including natural conception, ovulation induction, artificial insemination, surgical treatment, etc.), long duration of disease and advanced age. Pre-treatment with GnRHa for 2 to 3 months prior to IVF-ET is recommended to help improve the success rate of assisted conception. The duration of drug administration is adjusted according to the severity of endometriosis and ovarian reserve of the patient.