The concurrence of endometriosis and polycystic ovarian syndrome in the pattern of female infertility


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Abstract

Endometriosis and polycystic ovary syndrome (PCOS) are the most common causes of female infertility. Along with discussions about the etiology, mechanisms of pathogenesis, and treatment regimens for both endometriosis and PCOS, there are a number of issues related to the concurrence of different diseases associated with infertility. One of these dilemmas is the coexistence of external genital endometriosis (EGE) and PCOS in one patient. Many aspects of this association are of clinical interest. The paper analyzes the literature data on the main problems of infertility treatment in patients with EGE, PCOS, and their concurrence. Most of the works of interest confirm the fact that EGE may coexist with PCOS in one patient. At the same time, there are very few data on the effect of the concurrence on the rate of pregnancy and its course and the efficiency of infertility treatment, by using assisted reproductive technologies (ART). In most cases of this association, there are minor forms of endometriosis, more often asymptomatic ones. The information obtained may lead to the conclusion that the concurrence of endometriosis and PCOS has a negative effect on the occurrence of pregnancy. It remains unclear whether this concurrence causes a change in the quality of oocytes. It is noted that the pathogenesis of both endometriosis and PCOS involves a number of common factors, one of which is oxidative stress (OS), the development of which results in lower success rates of IVF-ICSI cycles. The “freeze-all” strategy is proposed to overcome the negative impact of OS on the efficiency of infertility treatment during ART cycles. Conclusion. The small volume of scientific publications on the stated topic indicates a direction for future research that opens up prospects for improving the treatment of infertility in women with the concurrence of endometriosis and PCOS. Treatment for the implementation of reproductive function in these patient groups should be strictly individualized, taking into account all the features of the concurrence of endometriosis and PCOS.

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About the authors

Vitaly F. Bezhenar

I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation

Email: bez-vitaly@yandex.ru
Dr. Med. Sci., Professor

Alla S. Kalugina

I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of the Russian Federation

Email: alla19021962@gmail.com
Dr. Med. Sci., Associate professor

Alexander A. Makolkin

Delta Fertility Clinic

Email: mail@makolkin.com
obstetrician-gynecologist, reproductologist

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