Elizur Shai E, Mostafa Jollanar, Berkowitz Elad, Orvieto Raoul
IVF Unit and the Endometriosis Center, Sheba Medical Center, Tel-HaShomer, 52621, Ramat Gan, Israel.
The Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
Arch Gynecol Obstet. 2025 Jul 21. doi: 10.1007/s00404-025-08124-1.
Endometriosis is a chronic gynecological disorder characterized by ectopic endometrial-like tissue, leading to pain, dysmenorrhea, and infertility. This review explores classification systems, the mechanisms of endometriosis-related infertility, and the impact of endometriosis subtypes on fertility outcomes. Medical therapies, such as hormonal suppression, alleviate symptoms but are unsuitable for women who wish to conceive. Surgery may enhance natural conception rates in select cases but may have a negative impact on ovarian reserve. Assisted reproductive technologies, such as intrauterine insemination and in vitro fertilization, provide effective fertility treatments. However, endometriosis can negatively affect oocyte quality and implantation rates.Given the complexity of endometriosis and its varying impact on fertility, a personalized, multidisciplinary approach is recommended. This review proposes an updated treatment algorithm that integrates clinical, imaging, and other infertility causes to optimize treatment outcomes. Future research is needed for refining classification systems and indications for fertility-preservation treatments, as well as improving assisted reproductive technology success rates.
子宫内膜异位症是一种慢性妇科疾病，其特征是存在异位的子宫内膜样组织，可导致疼痛、痛经和不孕。本综述探讨了分类系统、子宫内膜异位症相关不孕的机制，以及子宫内膜异位症亚型对生育结局的影响。激素抑制等药物治疗可缓解症状，但不适用于希望怀孕的女性。手术在某些情况下可能会提高自然受孕率，但可能对卵巢储备产生负面影响。宫腔内人工授精和体外受精等辅助生殖技术提供了有效的生育治疗方法。然而，子宫内膜异位症会对卵母细胞质量和着床率产生负面影响。鉴于子宫内膜异位症的复杂性及其对生育的不同影响，建议采用个性化的多学科方法。本综述提出了一种更新的治疗算法，该算法整合了临床、影像学和其他不孕原因，以优化治疗效果。未来需要开展研究，以完善分类系统和生育力保护治疗的指征，并提高辅助生殖技术的成功率。
