Deep infiltrative endometriosis and fertility

Bezhenar V.F., Linde V.A., Kuzmina N.S., Krylova N.Yu., Lyogonkaya A.Yu.

1) Pavlov First St. Petersburg State Medical University, Ministry of Health of Russia, St. Petersburg, Russia; 2) City Hospital No. 2, St. Petersburg, Russia

The review is based on resources from the following databases: CyberLeninka, PubMed, MedArt, and the Central Scientific Medical Library. Endometriosis is a common non-infectious pathology of the female reproductive system associated with the risk of infertility and obstetric problems. Deep infiltrative endometriosis (DIE) is considered an independent form or a distinct phenotype of endometriosis. Endometriosis in general and DIE in particular are associated with a decrease in both fertility and the effectiveness of assisted reproductive technologies. Pregnant women with DIE are at a higher risk of miscarriage, preterm labor and pre-eclampsia. The labor of patients after surgical treatment of DIE often ends in caesarean section. The present literature review is based on data obtained over the last 16 years and aims to assess the main links in the pathogenesis underlying the negative impact of DIE on women’s fertility.
Conclusion: Extragenital endometriosis, as well as DIE, appears to be a significant reproductive issue. Ovulatory reserve may decrease significantly with recurrent DIE and repeated surgical interventions. Pregnancy in this cohort of women is associated with an increased risk of cervical incompetence, threatened miscarriage and pre-eclampsia. The indications for surgical delivery by caesarean section should not be unreasonably extended due to the presence of colorectal anastomosis and unremoved endometrioid infiltrate.

Authors’ contributions: Bezhenar V.F., Linde V.A. – developing the concept and design of the study, writing the text; Kuzmina N.S., Krylova N.Yu. – collecting and processing the material; Lyogonkaya A.Yu. – collecting the material, editing the text.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Bezhenar V.F., Linde V.A., Kuzmina N.S., Krylova N.Yu., Lyogonkaya A.Yu.
Deep infiltrative endometriosis and fertility.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (4): 22-28 (in Russian)
https://dx.doi.org/10.18565/aig.2025.1

Keywords

endometriosis
deep infiltrative endometriosis
infertility
fertility

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Received 03.01.2025

Accepted 21.03.2025

About the Authors

Vitaly F. Bezhenar, Dr. Med. Sci., Professor, Head of the Department of Obstetrics, Gynecology and Neonatology, Department of Obstetrics, Gynecology and Reproductology, Head of the Clinic of Obstetrics and Gynecology, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia,
197022, Russia, Saint Petersburg, L’va Tolstogo str., 6-8; Chief External Expert for Obstetrics and Gynecology of the Health Committee of the Government of St. Petersburg, +7(812)338-67-15, bez-vitaly@yandex.ru, https://orcid.org/0000-0002-7807-4929
Viktor A. Linde, Dr. Med. Sci., Professor, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, Saint Petersburg,
L’va Tolstogo str., 6-8, +7(812)338-67-15, vik-linde@yandex.ru, https://orcid.org/0000-0002-6032-1936
Natalia S. Kuzmina, PhD, Head of the Oncology Department No. 7 (Oncogynecology), Teaching Assistant at the Department of Obstetrics, Gynecology and Neonatology, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, 197022, Russia, St. Petersburg, Leo Tolstoy str., 6-8, +7(812)338-67-15,
dok.kuzmina@gmail.com, https://orcid.org/0000-0001-5759-4530
Nadezhda Yu. Krylova, PhD, obstetrician-gynecologist, City Hospital No. 2, 194354, Russia, Saint Petersburg, Uchebnyi per., 5, +7(812)338-48-88, dr-nadiezhda@mail.ru, https://orcid.org/0000-0002-0895-6619
Anzhelika Yu. Lyogonkaya, obstetrician-gynecologist, City Hospital No. 2, 194354, Russia, Saint Petersburg, Uchebnyi per., 5, +7(906)959-22-827, anzhelika_l_l@mail.ru, https://orcid.org/0009-0006-6556-6832
Corresponding author: Anzhelika Yu. Lyogonkaya, anzhelika_l_l@mail.ru

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