Médecine de la Reproduction


What information should be given to women with endometriosis about their future fertility? Volume 24, issue 4, Octobre-novembre-décembre 2022


1 Service de chirurgie gynécologique et du sein, GH Diaconesses Croix Saint-Simon, Paris, France.
2 Université de Paris, faculté de santé, faculté de médecine Paris Centre, Paris, France
3 Département de gynécologie obstétrique II et médecine de la reproduction (Pr Chapron), AP-HP, hôpital universitaire Paris Centre (HUPC), CHU Cochin, Paris, France
4 Université Paris XIII, service de médecine de la reproduction hôpital Jean Verdier Bondy 93.100 (AP-HP)
5 Département “Développement, reproduction et cancer”, institut Cochin, Inserm U1016 (Pr Batteux), Paris, France
* Tirés à part : J. Boujenah

Although endometriosis may cover very different clinical situations, it seems possible to provide rational information to women asking for their fertility status: (i) Age is the only relevant, reproducible factor for predicting woman’s fertility. (ii) Infertility related to endometriosis may affect 20-30 % of women. (iii) After surgery for endometriosis, women who have never tried to conceive before should not be considered as infertile. Regarding women who have undergone surgery for endometriosis related to infertility, a multidisciplinary assessment guided by the endometriosis fertility index (EFI)and other main fertility factors is recommended to individualize the management. (iv) Surgery for endometriosis provides a good opportunity for an overall discussion on the different factors of infertility, keeping in mind the lack of robust model able to predict spontaneous conception. (v) In absence of previous surgery, natural attempt of conception should be favored as much as possible during the next 6 to 12 months. (vi) Women with endometriosis and a risk of altered ovarian function should consider oocyte freezing to preserve any subsequent fertility project. (vii) Assessment of pain and other fertility parameters may be offered in multidisciplinary reference center with the full range of available therapeutic options (surgery, assistance reproductive technology, medical and gynecological support for pain and fertility preservation).

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