Endometriosis: why assisted reproduction?

Vergara Herrera C.A.; Vergara Ascenzo C.A.; Ascenzo Battistini A.G.; Duarte C.; Ascenzo Palacio A. · Revista Peruana de Ginecologia y Obstetricia (2026) · DOI: 10.31403/rpgo.v71i2814

Resumen

Endometriosis is a chronic, estrogen-dependent gynecological disease that affects approximately 10% of women of reproductive age and is associated with infertility in up to 50% of cases^[1]. The link between endometriosis and infertility is explained by anatomical distortion, peritoneal inflammation, decreased ovarian reserve, and impaired endometrial receptivity^[2]. Traditionally, laparoscopic surgery has been used as a first-line approach to restore pelvic anatomy; however, its benefits in terms of live birth rates are limited and it carries the risk of reducing ovarian reserve.^[3] In contrast, in vitro fertilization (IVF) has demonstrated higher cumulative pregnancy rates in a shorter time, bypassing the anatomical and pathophysiological barriers of the disease^[4]. International societies such as ESHRE currently discourage routine surgery before IVF and recommend prioritizing assisted reproduction, reserving surgical intervention for selected cases: severe pelvic pain, large endometriomas (>4 cm) preventing access to follicles during oocyte retrieval^[5], or those suspicious for malignancy, given the 1-1.5% increased risk of ovarian cancer in these patients^[6, 7, 8]. Surgery is also indicated in cases of hydrosalpinx or organ involvement.^[5]. This review summarizes the most recent evidence and argues why assisted reproduction should be considered the central strategy in managing endometriosis-associated infertility. Copyright