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Review
. 2022 Oct 26:13:1020827.
doi: 10.3389/fendo.2022.1020827. eCollection 2022.

Endometriosis-associated infertility: From pathophysiology to tailored treatment

Giulia Bonavina  1 , Hugh S Taylor  1
Affiliations
Review

Endometriosis-associated infertility: From pathophysiology to tailored treatment

Giulia Bonavina et al. Front Endocrinol (Lausanne). .

Abstract

Despite the clinically recognized association between endometriosis and infertility, the mechanisms implicated in endometriosis-associated infertility are not fully understood. Endometriosis is a multifactorial and systemic disease that has pleiotropic direct and indirect effects on reproduction. A complex interaction between endometriosis subtype, pain, inflammation, altered pelvic anatomy, adhesions, disrupted ovarian reserve/function, and compromised endometrial receptivity as well as systemic effects of the disease define endometriosis-associated infertility. The population of infertile women with endometriosis is heterogeneous, and diverse patients' phenotypes can be observed in the clinical setting, thus making difficult to establish a precise diagnosis and a single mechanism of endometriosis related infertility. Moreover, clinical management of infertility associated with endometriosis can be challenging due to this heterogeneity. Innovative non-invasive diagnostic tools are on the horizon that may allow us to target the specific dysfunctional alteration in the reproduction process. Currently the treatment should be individualized according to the clinical situation and to the suspected level of impairment. Here we review the etiology of endometriosis related infertility as well as current treatment options, including the roles of surgery and assisted reproductive technologies.

Keywords: endometrial receptivity; endometriosis; in-vitro fertilization (IVF); infertility; ovarian reserve; pathogenesis; stem cell.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Theories of Endometriosis Pathogenesis. SF-1, steroidogenic factor 1;GATA6, GATA binding protein 6;PGE2, Prostaglandin E2;COX2, cyclooxygenase-2;ESR-2, estrogen receptor alpha; HOXA10, homebox protein A10;PR-B, progesterone receptor isoform B; GATA2, GATA binding protein 2.
Figure 2
Figure 2
Summary of the main pathophysiological processes implicated in endometriosis associated infertility.
Figure 3
Figure 3
Current and emerging treatment options for endometriosis related infertility.
See this image and copyright information in PMC

Comment in

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