International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 1999
Endometriosis and infertility: an integrated approach.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Ledger W L
Аннотация
OBJECTIVE: To define an integrated approach to endometriosis-associated infertility.
METHODS: Review of published literature with grading of evidence by quality.
RESULTS: Laparoscopy remains the investigation of choice in cases of endometriosis-associated infertility and allows the possibility of surgical ablation at diagnosis. This improves fertility in minimal/mild disease, whereas danazol therapy has no benefit. Both in vitro fertilization (IVF) and superovulation with intrauterine insemination improve fertility in mild/minimal disease. Neither surgery nor medical treatment have been shown to improve fertility in moderate/severe disease. IVF with prolonged pituitary down-regulation produced by long-acting gonadotropin-releasing hormone agonists after surgical debulking offers the best hope in such cases.
CONCLUSIONS: Endometriosis-related infertility should be treated as rapidly as possible with thorough investigation and the minimum delay between diagnosis and therapy.
METHODS: Review of published literature with grading of evidence by quality.
RESULTS: Laparoscopy remains the investigation of choice in cases of endometriosis-associated infertility and allows the possibility of surgical ablation at diagnosis. This improves fertility in minimal/mild disease, whereas danazol therapy has no benefit. Both in vitro fertilization (IVF) and superovulation with intrauterine insemination improve fertility in mild/minimal disease. Neither surgery nor medical treatment have been shown to improve fertility in moderate/severe disease. IVF with prolonged pituitary down-regulation produced by long-acting gonadotropin-releasing hormone agonists after surgical debulking offers the best hope in such cases.
CONCLUSIONS: Endometriosis-related infertility should be treated as rapidly as possible with thorough investigation and the minimum delay between diagnosis and therapy.