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. 2024 Jan 13;13(2):444.
doi: 10.3390/jcm13020444.

The Prevalence of Endometriosis in Patients with Unexplained Infertility

Camran Nezhat  1   2   3 , Farrah Khoyloo  3   4 , Angie Tsuei  1   3 , Ellie Armani  3 , Barbara Page  3   4 , Thomas Rduch  5   6 , Ceana Nezhat  7
Affiliations

The Prevalence of Endometriosis in Patients with Unexplained Infertility

Camran Nezhat et al. J Clin Med. .

Abstract

Endometriosis, a systemic ailment, profoundly affects various aspects of life, often eluding detection for over a decade. This leads to enduring issues such as chronic pain, infertility, emotional strain, and potential organ dysfunction. The prolonged absence of diagnosis can contribute to unexplained obstetric challenges and fertility issues, necessitating costly and emotionally taxing treatments. While biopsy remains the gold standard for diagnosis, emerging noninvasive screening methods are gaining prominence. These tests can indicate endometriosis in cases of unexplained infertility, offering valuable insights to patients and physicians managing both obstetric and non-obstetric conditions. In a retrospective cross-sectional study involving 215 patients aged 25 to 45 with unexplained infertility, diagnostic laparoscopy was performed after unsuccessful reproductive technology attempts. Pathology results revealed tissue abnormalities in 98.6% of patients, with 90.7% showing endometriosis, confirmed by the presence of endometrial-like glands and stroma. The study underscores the potential role of endometriosis in unexplained infertility cases. Although the study acknowledges selection bias, a higher than previously reported prevalence suggests evaluating endometriosis in patients who have not responded to previous reproductive interventions may be justified. Early detection holds significance due to associations with ovarian cancer, prolonged fertility drug use, pregnancy complications, and elevated post-delivery stroke risk.

Keywords: endometriosis; endometriosis and cancer; endometriosis and ovarian hyperstimulation; pregnancy complications; prevalence; unexplained infertility.

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Conflict of interest statement

None of the authors have a conflict of interest.

Figures

Figure 1
Figure 1
This flow chart represents a summary of the examination that was performed when determining which patients were eligible for this study.
Figure 2
Figure 2
(A) Endometriosis of serosa and subserosa of the left ureter in a patient with unexplained infertility, with failed IVF and IUI cycles. (B) Filmy peritubal and periovarian adhesions in a patient with normal HSG. (C) A case of severe endometriosis with normal HSG and imaging and transvaginal ultrasound. (D) Suspicious lesions for endometriosis have been biopsied.
Figure 3
Figure 3
The prevalence of endometriosis in patients with unexplained infertility. This flow chart presents a summary of the diagnosis methodology.
See this image and copyright information in PMC

References

    1. Chapron C., Marcellin L., Borghese B., Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat. Rev. Endocrinol. 2019;15:666–682. doi: 10.1038/s41574-019-0245-z. - DOI - PubMed
    1. Noël J.-C., Chapron C., Bucella D., Buxant F., Peny M.-O., Fayt I., Borghese B., Anaf V. Estrogen and progesterone receptors in smooth muscle component of deep infiltrating endometriosis. Fertil. Steril. 2010;93:1774–1777. doi: 10.1016/j.fertnstert.2008.12.114. - DOI - PubMed
    1. Donnez J. Introduction: From pathogenesis to therapy, deep endometriosis remains a source of controversy. Fertil. Steril. 2017;108:869–871. doi: 10.1016/j.fertnstert.2017.10.015. - DOI - PubMed
    1. Koninckx P.R., Ussia A., Adamyan L., Wattiez A., Donnez J. Deep endometriosis: Definition, diagnosis, and treatment. Fertil. Steril. 2012;98:564–571. doi: 10.1016/j.fertnstert.2012.07.1061. - DOI - PubMed
    1. Vercellini P., Viganò P., Somigliana E., Fedele L. Endometriosis: Pathogenesis and treatment. Nat. Rev. Endocrinol. 2014;10:261–275. doi: 10.1038/nrendo.2013.255. - DOI - PubMed

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