| Abstract | Endometrioza je kronična upalna ginekološka bolest koja najčešće zahvaća žene reproduktivne dobi. Definirana je prisutnošću benignog funkcionalnog endometrijskog tkiva izvan endometrija maternice. Lokalizacija endometrijskog tkiva, njegov makroskopski izgled, simptomi i njihova težina te odgovor na liječenje endometrioze iznimno su varijabilni. Zlatni standard dijagnosticiranja endometrioze jest laparoskopska kirurgija. Uz dismenoreju, dispareuniju, menometroragiju te kroničnu zdjeličnu bol, pacijentice s endometriozom često se susreću sa smanjenom plodnosti i neplodnosti. Neplodnost definiramo kao nemogućnost ostvarivanja trudnoće nakon najmanje godinu dana redovitih nezaštićenih spolnih odnosa, dok je smanjena plodnost postizanje trudnoće nakon dužeg vremenskog razdoblja nego što se očekuje u uobičajeno plodnog para. Odnos između endometrioze i neplodnosti klinički je prepoznat i znanstveno dokazan, iako je jasna uzročno-posljedična povezanost nepoznata. Potencijalni uzroci neplodnosti povezane s endometriozom su raznoliki - kronična upala i priraslice u zdjelici, hormonski i imunološki poremećaji, uništavanje zdravog tkiva jajnika uz smanjenje ovarijske rezerve, oštećenje jajovoda, smanjena receptivnost endometrija, itd. Pristup liječenju neplodnosti kod žena s endometriozom iznimno varira i ovisi o dobi, lokalizaciji i proširenosti bolesti, pridruženim stanjima, postojanju drugih simptoma endometrioze, ovarijskoj rezervi i prethodnim kirurškim zahvatima. U pacijentica s minimalnom i blagom endometriozom vjerojatnost spontanog začeća tek je nešto niža u usporedbi s parovima kod kojih postoji nerazjašnjeni uzrok neplodnosti. Stoga se takvim pacijenticama preporučuje ekspektativni pristup. Medikamentno liječenje pokazalo se učinkovitim u liječenju boli uzrokovanoj endometriozom, u postizanju anovulacije te u poboljšanju kvalitete života. Nasuprot tome, ne postoje dokazi da medikamentno liječenje boli utječe na poboljšanje plodnosti. Budući da u literaturi postoje nesuglasice oko kirurškog pristupa endometriozi i neplodnosti povezanoj s endometriozom, stručna društva izdala su smjernice koja bi trebala olakšati pristup ženama kojima bi kirurško liječenje pomoglo u smanjenju simptoma i poboljšanju plodnosti. In vitro fertilizacija (IVF) nedvojbeno je najdjelotvornija terapija u liječenju neplodnosti povezane s endometriozom. Nedvojbeno je da IVF maksimalizira fekunditet, osobito u pacijentica s umjerenom i teškom endometriozom kod kojih postoje izmijenjeni anatomski odnosi u zdjelištu. |
| Abstract (english) | Endometriosis is a chronic inflammatory gynecological disease that most commonly affects women of reproductive age. It is defined by the presence of benign functional endometrial tissue outside of the uterine endometrium. The localization of endometrial tissue, its macroscopic appearance, symptoms and their severity, and the response to treatment are highly variable. The gold standard for diagnosing endometriosis is laparoscopic surgery. Alongside dysmenorrhea, dyspareunia, metrorrhagia, and chronic pelvic pain, patients with endometriosis often encounter reduced fertility and infertility. Infertility is defined as the inability to achieve pregnancy after at least one year of regular unprotected intercourse, while reduced fertility refers to achieving pregnancy after a longer time than expected for fertile couples. The relationship between endometriosis and infertility is clinically recognized and scientifically proven, although the clear causal link remains unknown. Potential causes of infertility associated with endometriosis are diverse, including chronic inflammation and pelvic adhesions, hormonal and immune disorders, destruction of healthy ovarian tissue and reduction of ovarian reserve, fallopian tube damage, and reduced endometrial receptivity, among others. The approach to treating infertility in women with endometriosis varies greatly and depends on factors such as age, disease localization and its extent, associated conditions, the presence of other symptoms, ovarian reserve, and previous surgical interventions. In patients with minimal and mild endometriosis, the likelihood of spontaneous conception is only slightly lower compared to couples with unexplained infertility. Therefore, an expectant approach is recommended for these patients. Medical treatment has proven effective in managing pain caused by endometriosis, achieving anovulation, and improving the quality of life. In contrast, there is no evidence that pain medication improves fertility. Due to discrepancies in the literature regarding the surgical approach to endometriosis and infertility associated with endometriosis, professional organizations have issued guidelines to facilitate the approach to women who could benefit from surgical treatment to reduce their symptoms and improve fertility. In vitro fertilization (IVF) is unequivocally the most effective therapy in treating infertility associated with endometriosis. IVF maximizes fecundity, particularly in patients with moderate and severe endometriosis where distorted pelvic anatomy is present. |
