Hormonal Therapies before In-Vitro Fertilization in Women with Endometriosis

Endometriosis is a disease known to have a detrimental effect on the female’s fertility. In-vitro fertilization (IVF) is generally an acceptable modality to manage infertile patients with endometriosis. Nevertheless, the IVF outcomes in this population are generally suboptimal. The prolonged administration of hormonal medications before starting the IVF cycles, namely gonadotropin-releasing hormone (GnRH) agonists, progestins, and aromatase inhibitors, was suggested years ago as an effective modality in improving the fertility outcomes of patients with endometriosis. However, many controversial points of view and contradictory data regarding the clinical implication of these treatment strategies were reported. We ran a broad-scope literature review, and included all studies and systematic reviews reporting on the feasibility of hormonal treatments before IVF cycles in patients with endometriosis. Although the general quality of available evidence is low, ultralong GnRH agonist protocols are no longer acceptable to treat patients with mild endometriosis. In contrast, growing evidence suggests that a group of patients with severe endometriosis could benefit from the ultralong administration of GnRH agonists before IVF cycles. Dienogest and aromatase inhibitors seem promising, but it is too early to make clinical recommendations. Clinicians and researchers should keep in mind that endometriosis is more than hormonal dysregulation, and start investigating the possible non-hormonal alternatives to improve the IVF outcomes of patients with endometriosis-related infertility.