What are the latest ESHRE recommendations on endometriosis-associated infertility?
[Verified against ESHRE Guideline: Endometriosis 2022 — note this is the current version; there is no 2024 guideline, despite citations to that effect elsewhere in this corpus] Core recommendations affecting ART: Routine surgery prior to ART to improve live birth rate is not recommended (strong). Routine surgery for ovarian endometrioma prior to ART to improve live birth rates is not recommended, as current evidence shows no benefit (strong). Extended GnRH agonist administration prior to ART — the ultralong protocol — is not recommended, as benefit is uncertain (strong). This was withdrawn from the previous version of the guideline. The decision to offer surgical excision of deep endometriosis lesions prior to ART should be individualised (strong). Where surgery is performed for other indications: Surgery for endometrioma prior to ART can be considered to improve endometriosis-associated pain or accessibility of follicles. Cystectomy is recommended over drainage and coagulation, as it reduces recurrence. A tool added in this version: the Endometriosis Fertility Index, included as a step in the treatment pathway to support decision-making on the most appropriate route to pregnancy after surgery. It is under-used in practice and worth incorporating into post-operative counselling. Also withdrawn in this version: presacral neurectomy and anti-adhesion agents are no longer included in recommendations, though still discussed in the text. The overall direction is toward less pre-ART surgical intervention, not more.
Sources
- ESHRE Guideline: Endometriosis (2022)
Review by Fertility Connect Medical Team Pending
This information is general and does not replace advice from your own clinician.