Endometriotic cyst and infertility

Endometriosis, a common condition in women of reproductive age, is very frequently associated with infertility. The causes of infertility in women with endometriosis range from anatomical distortions to endocrine abnormalities and immunological disturbances: a) disturbance of pelvic anatomy especially in women with severe disease; b)prostaglandin overproduction and inflammatory mediators determining a hostile peritoneal environment; c) altered endometrial receptivity; d) myometrium structure changes in adenomyosis; e) decreased ovarian reserve and oocyte quality due to the presence of endometrioma or as a consequence of the surgically related damage; and f) hormonal dysregulation with anovulation and premature luteinization. Despite the extensive and interdisciplinary investigations already conducted, all the listed pathophysiological mechanisms in infertility patients with endometriotic ovarian cyst have not always been clearly understood. Nonetheless, endometriosis significantly interferes with women's overall health and well-being, and it is also linked with a decreased ovarian reserve and adverse outcomes of infertility management procedures. Treatment strategies for endometriotic ovarian cyst in infertility patients are different, depending on a number of factors. The surgical approach remains controversial, as it has been associated with ovarian reserve impairment. Medications alone have little or no effect and should be combined with assisted reproductive technology procedures. IVF is an efficient treatment option in patients with a mild and moderate stage of the disease. Although recently published studies have shown that a combination of medical, surgical, and psychological treatment was found beneficial in patients suffering from endometriosis-related infertility, there is still a lack of consensus that this specific combination can enhance the fertility success rate. Generally, management of endometriotic ovarian cyst in infertility patients includes a surgical procedure (usually with a minimally invasive approach) and ovulation induction with intrauterine insemination or in vitro fertilization. Fertility preservation technologies also include oocyte or embryo freezing and ovarian tissue cryopreservation. As the management of patients with endometriotic cysts remain controversial, a multidisciplinary approach is a key factor in achieving the best outcome, along with appropriate patient counselling.