The prevalence of endometriosis in unexplained infertility: a systematic review.
Level 1 - systematic review of randomized trials
Systematic review of observational/prevalence studies.
PubMed 38943813 · doi:10.1016/j.rbmo.2024.103848
What was done
A systematic review was conducted across PubMed, Embase, and Cochrane Central to identify studies assessing pelvic pathologies detected by diagnostic laparoscopy in couples with unexplained infertility. Inclusion criteria required normal ovulatory cycles, normal semen analysis, and an infertility duration of at least 12 months.
What was found
The prevalence of endometriosis identified via laparoscopy was 44%, with 74% of lesions classified as minimal or mild. Tubal factors were identified in 20% and pelvic adhesions in 16% of patients. Pelvic abnormalities were detected more frequently in women who had undergone prior fertility treatment (75%) compared to those without prior fertility treatment (53%).
Why it matters
Even with modern non-invasive imaging, occult pelvic pathologies—particularly early-stage endometriosis—remain common in unexplained infertility, supporting laparoscopy considerations especially when pain symptoms are present.
Limits
The abstract does not report the total number of included studies, overall participant sample size, study date ranges, confidence intervals, or meta-analytic heterogeneity, nor does it address clinical pregnancy outcomes following surgical diagnosis.
Cited by
- supports Fifty percent of patients presenting with unexplained infertility are ultimately found to have endometriosis.