The Epidemiology of Infertility in Women with Endometriosis

Infertility is commonly associated with endometriosis. Epidemiological studies suggest that the monthly probability of conception is about 2–5-fold lower in women with endometriosis than in normal couples. Considering infertile women, endometriosis has been diagnosed in about 25% of them, but marked differences are observed in this estimate among studies. It is a common thought that pelvic anatomy distortion can explain infertility in patients with severe forms of endometriosis. This mechanism is supported by the observation that infertility is associated with the value of the “Endometriosis fertility index” that takes into account, with the American Society Reproductive Medicine (ASRM) score, the functional status of the fallopian tubes, ovaries, and fimbriae and some clinical characteristics such as woman’s age, duration of infertility, and previous pregnancies. A further factors associated with infertility in women with endometriosis is the presence of adenomyosis. In conclusion, not all women with endometriosis had infertility: about 25% of women with clinically evident endometriosis will experience infertility during their life, and conversely about 25% of infertile women will be diagnosed with endometriosis.