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Endometrial changes in women with endometriosis may be responsible for unsuccessful implantation


Asynchronous development of the endometrium in some subfertile women may account for the failure of the embryo to implant during the highly controlled implantation window. The mechanisms by which endometriosis impairs fertility are varied, from distortion of pelvic anatomy to negative effects on implantation. Recent evidence has suggested that endometriosis is associated with an impairment of normal epithelial differentiation, resulting in morphological and biochemical heterogeneity of the endometrium. The resultant asynchrony between an implanting blastocyst and the endometrium may be a contributory factor in early pregnancy failure in women with endometriosis.

Although both medical and surgical management of endometriosis have been associated with an improvement of symptoms, the effect on fertility potential is still a matter of much debate, thus requiring further research. In women with endometriosis, long-term treatment (3-6 months) with GnRH-a before initiation of IVF treatment may allow the endometrium to be "reset in-phase", thus increasing the clinical pregnancy rate.
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