Background - Endometriosis is a gynecological disease characterized by the presence of endometrial tissue outside the uterine cavity. It is one of the leading causes of pelvic pain and female infertility. But, the effectiveness of endometriosis treatments prior to ART is not stablished until now. Objectives - To know if medication and/or surgical treatments of endometriosis, prior to in vitro fertilization (IVF) in women with infertility, positively influence pregnancy rates. Search Methods - We systematically reviewed randomized clinical trials with the following interventions: use of oral contraceptives, use of GnRH analogues, laparoscopy with endometrioma excision, laparoscopy with cauterization of endometriosis foci, and, finally, resection surgery of endometrioma followed by the use of GnRh. We found 5,834 articles in the following literature databases: Science Direct, Cochrane Controlled Trials Register (CCTR), Cochrane Database of Systematic Reviews (CDSR), EMBASE, Medline, PubMed and Reference lists. Selection Criteria - We included randomized and non-randomized controlled trials that compared the results of IVF patients with endometriosis that had previously undergone treatment to those with no treatment (controls). It was compulsory for the groups to include: (1) a control group without treatment and one of the following: (2) a group that had previously undergone surgery; (3) a group that had undergone a prior medication treatment; (4) a group that had previously undergone medication and surgery treatment. Data Collection and Analysis - Three authors (Bertoncelo, Gualberto and Millani) were responsible for the database research and were assigned to screen the titles and abstracts in order to discard studies that were clearly ineligible. Titles and abstracts were independently reviewed by two authors (Souza and Sanchez) to check for duplicates. Two authors (Silva and Bertoncelo) independently analyzed potential sources of bias according to the Cochrane Collaboration's Criteria as well as the validity of each study. A third reviewer (Faria Jr) checked the data and any disagreement was resolved by arbitration with a fourth author (Bartmann). We used meta-analysis softwares R Statistical software (version 3.02) with Metaphor and meta library to calculate odds ratio (OR), assess statistical heterogeneity between studies and determine meta-analysis outcomes. Main Results - Of the 5,834 articles found in the databases, 2,871 were relevant, from which, 8 were selected for this review. A total of 1,199 women were included in the study.Clinical pregnancy rates were significantly higher in women who had laparoscopic surgery (OR 2.19, 95% CI 1.12 to 4.28), who used GnRHanalogues prior to IVF (OR 1.77, 95% CI 1.07 to 2.93) and oral contraceptives (OR 2.65, 95% CI 1.57 to 4.47). Authors’ Conclusions - To the results, treatments in order to remove endometriosis tumors do not improve pregnancy rates after IVF. The administration of GnRH agonist and oral contraceptives with or without laparoscopic surgery increases pregnancy rates. The same occurs with laparoscopic surgery alone. The increase in the number of pregnancies justifies their use before IVF treatments in patients with endometriosis.
