Management of infertile women with pelvic endometriosis: a literature review.
Résumé
Introduction - Endometriosis is a condition that affects women's fertility. Several mechanisms are involved in this process: anatomical changes, mechanical, immune or inflammatory factors, ovarian reserve alterations... There are different types of strategies to treat endometriosis-related infertility: medical treatment, surgical treatment and/or techniques of medically assisted procreation. Evidence acquisition - We tried to consider various therapeutic strategies depending on the stage of the disease in order to offer appropriate management to patients with endometriosis who wish to become pregnant: we reviewed 58 articles between 1985 to 2016 searching in medline using the key words «endometriosis and infertility» and «infertility and endometriosis treatment». And we divided the patients in subgroups mild and severe endometriosis, in vitro fertilization (IVF) versus surgery in deep infiltrating endometriosis (DIE) and others. Evidence synthesis - Surgery appears to be the chief treatment for minimal to mild endometriosis in a context of infertility. Concerning deep infiltrating endometriosis, data in insufficient to decide on the best treatment although surgery associated with IVF seems to bring clinical benefit. Conclusions - Regarding optimal management of infertility - in case of stage III or IV endometriosis, there is yet no consensus. A multidisciplinary approach is essential in order to consider the various treatment options and provide optimum care and individualized to patients according to different parameters (patient age, degree of damage and location of DIE lesions, presence or absence of ovarian failure or other factors associated with subfertility, male infertility factors in the couple...). Indeed, optimal care of patients should be multidisciplinary and personalized.