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Médecine de la Reproduction

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How to evaluate the fertility of a woman with endometriosis and what information can be provided ? Volume 22, issue 2, Avril-Mai-Juin 2020

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Authors
1 Service de gynécologie et obstétrique, aide médicale à la procréation, centre hospitalier intercommunal de Poissy-St-Germain en Laye, université de Versailles - Saint Quentin en Yvelines, Poissy, France
2 Division of Child Health, Obstetrics & Gynaecology, Department of Obstetrics and Gynecology, University of Nottingham, City Hospital, Hucknall Road, Nottingham, United Kingdom
* Tirés à part

Endometriosis classically associates chronic pelvic pain with infertility of multifactorial nature (peritoneal inflammation, pelvic adhesions, impairment of the ovarian reserve (OR), of oocyte quality, and of embryo implantation). Infertility treatment can involve surgery and/or assisted reproductive techniques. In addition to classical tubal and semen assessments, the rigorous determination of the endometriosis’ extension and of the OR are crucial steps to inform the patient about her disease, her fertility and to plan the most appropriate treatment, as part of a shared medical decision. The extent of endometriosis and the potential risks of surgical treatments are assessed by clinical examination, pelvic ultrasounds scan and MRI performed by trained practitioners. The assessment of OR is based on the antral follicle count (AFC), the measurement of Day 3 FSH, LH, Estradiol and antimüllerian hormone (AMH). Even if they seem less relevant in case of endometriosis, these markers are predictive of the ovarian response to stimulation for IVF, which can be impaired by the disease itself but also worsened by its surgical treatment. Therapeutic decisions must be ratified by experts mustered in multidisciplinary team.