Date of Award

Spring 5-2025

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

McHugo, Jeanie

Keywords

endometriosis, fertility, treatment, in vitro fertilization (IVF), assisted reproductive therapy (ART), surgery, cystectomy

Abstract

Endometriosis is a common condition in women and has a strong association with infertility. The purpose of this literature review is to determine the efficacy of hormonal therapy as compared to surgical therapy before assisted reproductive therapy (ART) on endometriosis-related infertility. The electronic databases PubMed and Embase were searched from June 23, 2024, to January 4, 2025. Keywords used were associated with fertility, IVF, and endometriosis. Article selection was limited to research published after the year 2000 with a preference for randomized control trials (RCTs), although one pilot study and one clinical cohort study were also included. The search yielded 59 total articles. Exclusion criteria included lack of hard fertility endpoints including pregnancy rate or live birthrate, and any therapies that did not include either surgery or hormonal therapy in conjunction with ART. A total of seven articles were included in this review. Reviewed literature indicates that prior to ART, both surgical cystectomy and prolonged gonadotropin releasing hormone (GnRH) downregulation improves fertility outcomes in women with endometriosis. However, to date there are no published studies that directly compared the effects of hormonal therapy to surgical therapy on fertility in women with endometriosis, and future research should be conducted to determine and compare those effects to guide clinical decision making for women experiencing infertility secondary to endometriosis.

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