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High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners

2009; Elsevier BV; Volume: 93; Issue: 3 Linguagem: Inglês

10.1016/j.fertnstert.2009.11.027

1556-5653

Krithiga Ilangavan, Emmanuel Kalu,

Uterine Myomas and Treatments

To the Editor: We read with interest the article by Meuleman et al. (1Meulemann C. Vandenabeele B. Fieuws S. Spiessens C. Timmerman D. D'Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners.Fertil Steril. 2009; 92: 68-74Abstract Full Text Full Text PDF PubMed Scopus (328) Google Scholar). The high incidence of endometriosis (47%) and other pelvic pathology (29%) in this cohort makes a strong case to offer laparoscopy and hysteroscopy to couples with “unexplained infertility” (a diagnosis of exclusion). This diagnosis, however, requires confirmation of tubal integrity, and the issue is whether laparoscopy should be the first line investigation to establish tubal patency. The investigators did not say how many women in their cohort had a completely normal pelvis after laparoscopy and hysteroscopy. Their data put in another way showed that 53% of the women who underwent laparoscopy did not have endometriosis. It is in an effort to minimize the risks and costs associated with laparoscopy that the National Collaboration Centre for Women's and Children's Health (2National Collaboration Centre for Women's and Children's HealthClinical guideline 11: fertility. Assessment and treatment for people with fertility problems. National Collaboration Centre for Women's and Children's Health, United Kingdom2004Google Scholar) recommends that hysterosalpingogram be considered as first-line test for tubal patency and laparoscopy be considered only for women with comorbidity. Although the definition of comorbidity is fairly wholly and nonspecific, it generally refers to women whose clinical history may suggest the presence of potential pelvic pathology. This includes those who have had previous pelvic infection, previous ectopic pregnancy (EP), and known endometriosis. By limiting laparoscopy to this cohort, fewer women are exposed to the risks associated with this procedure and its potential cost implications. Also, as interesting as it is to know that laparoscopy revealed a high incidence of endometriosis and other “fertility-reducing pathologies” among the cohort of women studied, the investigators failed to discuss the outcome of the treatment of these pathologies. We must never lose sight of the fact that the ultimate aim of infertile women undergoing any type of treatment is to take home a baby. Until this is achieved, the patients may be thankful for having their asymptomatic endometriosis resected but will remain dissatisfied and consider the treatment a failure should they not have a baby at the end. It will be interesting to know how many women in this cohort had a live birth after surgery. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partnersFertility and SterilityVol. 92Issue 1PreviewTo determine the prevalence of histologically proven endometriosis in a subset of infertile women. Full-Text PDF Reply of the Authors: Endometriosis: is laparoscopy justified without previous ultrasonogram and magnetic resonance imaging (MRI)? & High prevalence of endometriosis in infertile women with normal ovulation and normospermic partnersFertility and SterilityVol. 93Issue 3PreviewWe thank colleagues Belaisch, Ilangavan, and Kalu for their interest in our work (1). Full-Text PDF