Table 2.
Examples of Endometriosis Guidelines and its level of evidence in treating infertility [56,58,77,78].
| Treatments for Infertility | Endometriosis Guidelines | ||||||
|---|---|---|---|---|---|---|---|
| ESHRE a (2022) |
NICE (2017) |
OGSM (2016) |
ASRM (2014) |
||||
| Surgical | Ablation | •• (M) | ✓ | ✓ (M) | ✓ (M) | ||
| Excision | •• (M) | ✓ | ✓ (M) | ✓ (M) | |||
| Excision of Ovarian Endometrioma | ✓ | ✓ (M) | ✓ (M) | ||||
| Ablation of Ovarian Endometrioma | ✓ | ✓ (M) | ✓ (M) | ||||
| Excision of Deep-Infiltrating Endometriosis | |||||||
| Adhesiolysis (Anti-adhesion Agents) | ✓ | ||||||
| Pharmacological | Combination Oral Contraceptives Pills | •• | ✓ | ✓ | ✓ | ||
| Danazol | X | ✓ | ✓ | ✓ | |||
| Dienogest | ✓ | ✓ | ✓ | ||||
| Medroxyprogesterone Acetate | ✓ | ✓ | ✓ | ||||
| Anti-Progesterone (Gestrinone) | ✓ | ✓ | ✓ | ||||
| Aromatose Inhibitors | ✓ | ✓ | |||||
| GnRH-Agonist | •• | ✓ | ✓ | ✓ | |||
| GnRH-Antagonist | ✓ | ||||||
| Selective Progesterone Receptor Modulators | ✓ | ||||||
| Selective Estrogen Receptor Modulators | ✓ | ||||||
| Assisted Reproduction Techniques (ART) | Intrauterine Insemination (IUI) | • | ✓ | ✓ (M) | |||
| In vitro fertilization/Intracytoplasmic sperm injection | •• | ✓ | ✓ | ||||
| First-Line of Treatment | Not Recommended d | •• | Low Evidence Level | M | Mild Endometriosis | ||
| Second-Line of Treatment | No Recommendation c | ••• | Moderate Evidence Level | ||||
| Third-Line of Treatment | Insufficient Evidence | GPP | Good Practice Point b | ||||
| Additional/Other Treatment | • | Very Low Evidence Level | ✓ | No Information of Evidence | |||
a The development of the ESHRE by the Guideline Development Group (GDG) categorized the quality of evidence using the GRADES approach, which is based on the level of confidence in the true effect compared to the estimated effect. The GRADES approach is categorized into “moderate” (•••), “low” (••), and “very low” (•) confidence level. b Good practice points (GPP) is given when experts from the GDG support and recommend the therapy. c The guideline did address the therapy but without stating the level of recommendation. d The guideline strongly suggests against the usage of the therapy.