Prevalence of Endometriosis in Sub-Fertile Women Confirmed at Laparoscopy: A Retrospective Analysis

Introduction: Endometriosis is a chronic, estrogen-dependent gynecological condition affecting approximately 3-10% of women of reproductive age [1]. The prevalence in infertile population could be up to 50% [2]. Laparoscopy is considered as the gold standard for diagnosing endometriosis. However, its invasive nature limits its routine use and currently limited to women symptomatic of endometriosis. Advance imaging techniques such as MRI, enhances the detection rate of deep infiltrating endometriosis but not as much for superficial/peritoneal endometriosis. This study aims to explore the prevalence of endometriosis in a sub-fertile population undergoing diagnostic laparoscopy. Methods: This retrospective study was conducted at Nottingham University Hospital between 01/07/2022 and 01/08/2023. Women who were referred from fertility and benign gynaecology clinics for laparoscopy and dye testing were included. The diagnosis of endometriosis was confirmed based on visual findings during laparoscopy. Patient characteristics, including age, BMI, type and reasons for subfertility, and laparoscopy finding were analysed. Results: A total of 100 women were included in the study, with the average age of 33.09 years in the endometriosis group. The prevalence of endometriosis within this cohort was found to be 55.34%, with 57 out of 100 women diagnosed. The subgroup (Endometriosis (Group 1) and other causes of sub-fertility (Group 2) analysis revealed a higher prevalence of endometriosis in women with primary infertility (36 vs. 21; p < 0.05). No significant differences were found between the demographic characteristics of the two groups including BMI or age (p = 0.709, p = 0.323). Out of 40 women who were initially thought to have unexplained infertility, 28 were found to have mild/moderate endometriosis in diagnostic laparoscopy. Conclusion: This study highlights a high prevalence of endometriosis (55.34%) among women undergoing diagnostic laparoscopy and dye testing. High prevalence of endometriosis in unexplained infertility emphasizes the importance of early diagnosis and intervention in improving reproductive outcomes. Further research is needed to examine the role of laparoscopy in different populations and to explore the broader implications of endometriosis in fertility management.