Role of surgery in treatment of infertile women with endometriosis: a review study

Endometriosis is a chronic inflammatory disease which affects fertility. This study was performed with aim to evaluate the clinical role of surgical intervention and assisted reproductive technology (ART) in infertile women with endometriosis on the basis of recent clinical guidelines.

In this review study, the published articles in the databases of PubMed, Science direct, Scopus, Google scholar were searched using the keywords of "endometriosis" and / or "endometrioma" and / or "assisted reproductive technology" and / or "infertility" and / or "laparoscopy" and / or "cystectomy" and / or "surgery" and/ or "guideline" from January of 2000 to November 2019. All guidelines published in English in the field of laparoscopy and surgery in endometriosis and infertility were reviewed.

Until now, 6 international guidelines have been published in this field and we reviewed these articles in the present study. According to the recent evidences, laparoscopy is not routinely performed prior to ART and its clinical application is to diagnose mild from moderate endometriosis; however surgical resection is considered if mild endometriosis is present, as it may improve the spontaneous pregnancy rate. In the case of more severe types of disease (endometrioma and deep penetrating endometriosis), the benefits of pre-ART surgery are still unclear and its risks and benefits should be assessed.

Based on the available guidelines, it is suggested that decision for surgery in infertile women with endometriosis should be made individually and on the basis of the patient’ selection, age and ovarian reserve, association with annoying symptoms, other causes of infertility, location of lesion and possible risk of repeated surgery.