Does the timing of endometriosis diagnosis affect optimal infertility treatment?

Research and innovation should prioritize early diagnosis for endometriosis.

Key Points

Importance:

• Research and innovation should prioritize improving the methodologies of early diagnosis for endometriosis.

Highlights:

• Research on non-invasive imaging techniques, other diagnostic tools, and continuous awareness will facilitate faster development.

What's done here:

• Based on a retrospective population-linked data study in "Human Reproduction", the ESHRE journal club featured a detailed debate.
• Fifty participants, including patients’ representatives, experts (Paola Vigano´, Mathew Leonardi, Thomas D’Hooghe, Louise Hull), and the authors of the original article, made a discussion.
• The discussion included the relevance of diagnosis timeliness and the reliability of linking national medical records. 

Key results:

The main questions discussed in the ESHRE journal club and then summarized in this paper were;

• Is delayed diagnosis still timely?
• Does early endometriosis diagnosis facilitate optimal infertility treatment?
• Do large databases inform on the effectiveness of endometriosis management?
• What is next? 

Lay Summary

Based on a retrospective population-linked data study in "Human Reproduction", the ESHRE journal club featured a detailed discussion with 50 participants, patients’ representatives, and experts (Paola Vigano´, Mathew Leonardi, Thomas D’Hooghe, Louise Hull), together with the authors of the original article, mainly concerning the relevance of diagnosis timeliness, and the reliability of linking national medical records. Dr. Sofia Makieva, from Zurich University, Swiss, and her colleagues penned this report as a summary of the above discussion and published it in the June 7 issue of "Human Reproduction". The main questions were;

• Is delayed diagnosis still timely?
• Does early endometriosis diagnosis facilitate optimal infertility treatment?
• Do large databases inform on the effectiveness of endometriosis management?
• What is next? 

Thirty percent of women are still diagnosed with endometriosis only after ART intervention in the last 15 years. It is apparent that pelvic imaging improvement may help with this issue. Recently updated ESHRE guidelines accept that pelvic imaging can identify endometriosis but cannot exclude the absence; laparoscopy may be required for diagnosis in symptomatic women with a negative ultrasound scan. Participants supported the discussion on improving the skills for non-invasive diagnosis and extending the practice beyond specialized centers with long waiting lists.

Finding based on "the similar chance for pregnancy in women with an endometriosis diagnosis prior to ART and women without endometriosis of same age undergoing ART, but a significant decrease in women entering an ART with undiagnosed endometriosis" the second question above is discussed. Participants agreed that ART and surgery could both have a role in the treatment of endometriosis-associated infertility, in line with ESHRE guidelines, and surgery can be useful when fertility goals are not met with ART, especially in patients with pain, endometriomas preventing egg retrieval and complicated deep endometriosis. However, surgery for endometriosis-associated infertility alone may not be necessary if ART is required.

Regarding the discussion on the reliability and the informativity of large databases, timely ‘diagnosis’ is considered a predictor of reproductive success in an observational study. However, journal club participants agreed that the most important future research step should be randomized controlled trials comparing surgery to ART for the improvement of fertility outcomes. Trials should be performed with the recruitment of a homogeneous population regarding the endometriosis stage, presence of ovarian endometrioma, pain, and patient/physician preference for a personalized approach. 

Research Source: https://pubmed.ncbi.nlm.nih.gov/35670743/