Fertility Preservation in Endometriosis

The number of original studies looking at fertility preservation in women with endometriosis is relatively low. Embryo cryopreservation and oocyte cryopreservation are the most common fertility preservation techniques used in patients with endometriosis. Clinical data on ovarian tissue cryopreservation in women with endometriosis are very scanty. It requires two surgical procedures: the first to harvest the ovarian tissue and the second for transplantation. Recent, more solid evidence showed that embryo and oocyte cryopreservation should be preferred to ovarian tissue cryopreservation. In addition, embryo and oocyte cryopreservation does not harm ovarian reserve and has low morbidity compared with ovarian cortex freezing. There is a lack of clinical consensus and guidelines for identifying patients with endometriosis who should be counseled to consider fertility preservation. Individualized counseling should include the patient’s age, familial history of premature ovarian insufficiency, markers of ovarian reserve, smoking, presence of endometriomas, previous surgery for endometriomas, extent, and progression of endometriosis and the need for extensive surgery involving the ovaries. Fertility preservation should be offered before surgery, especially before the excision of endometriomas which may impair the ovarian reserve.