Predictors of endometriosis in infertility

Abstract: Endometriosis is a gynecological disease associated with infertility, affecting 6–10% of reproductive-aged women. The current objective diagnosis of endometriosis is based on a visual assessment of abdominal and pelvic organs with obligatory histological verification of surgical materials. Meanwhile, the need for invasive surgery to identify endometrioid heterotopias slows down the diagnostic search, and it takes an average of about seven years from disease onset to diagnosis. Delayed diagnosis of endometriosis is often accompanied by adverse consequences as progression of the disease and development of untreatable infertility. Thus, the identification of significant noninvasive predictors for endometrioid disease, which are associated with infertility, will be able to identify a group of high-risk patients for this pathology and to speed up its diagnosis. According to the literature data studied, the reliable prognostic signs of endometriosis in infertility are premenstrual spotting, primary infertility, the unfavorable course of dysmenorrhea, the presence of nodules in the region of the sacrouterine ligaments or posterior vault, age, the duration of infertility, body mass index, the length of the menstrual cycle, repeated abortions, dyspareunia, chronic pelvic pain, and a family history of endometriosis. The independent predictive factors of severe infertility-associated endometriosis are age, education, the duration of infertility, body mass index, amount of menstrual blood loss, the duration of menstruation, dyspareunia, chronic pelvic pain, and a family history of endometriosis.
Conclusion: The design of special detailed questionnaires and diagnostic programs that are risk classifiers will contribute to the timely identification of patients having the greatest risk of developing endometriosis in infertility, who should mostly undergo immediate laparoscopy.