Women with endometrioma-related infertility face a dilemma when choosing the appropriate therapy: surgery or in vitro fertilization
Volume 110, Issue 7, Pages 1216–1217
Jacques Donnez, M.D., Ph.D.
Endometriosis, particularly ovarian endometriosis, is a disease detrimental to fertility. The exact pathophysiology of endometrioma-related infertility is still a source of debate, however, and a number of mechanisms have been suggested. It has been postulated that it distorts the tubo-ovarian anatomy or induces an inflammatory reaction followed by the so-called burn-out effect, which impacts the follicle reserve (1) and causes oxidative stress (2) resulting in poorer quality oocytes. Indeed, toxic content from an endometrioma may result in local inflammation, elevated oxidative stress levels, increased fibrosis, loss of cortex-specific stroma, smooth muscle cell metaplasia, and a diminished follicle reserve due to greater follicle atresia (1, 2).