A real-world simulation of the fertility trend among women with endometriosis in Italy

OBJECTIVES: to model a real-world probability curve of fertility rates in non-endometriotic and endometriotic women using demographic data and information from Italy. DESIGN: probabilistic simulation built from available data of Italian population. SETTING AND PARTICIPANTS: data from the Italian population of the years 2020-2023 were collected on: 1. the actual desire for pregnancy; 2. the infertility rate and outcomes of assisted reproductive technologies (ART); 3. the age at which endometriosis is diagnosed and the impact of endometriosis treatments on fertility; 4. the infertility rate in endometriotic patients and outcomes of ART; 5. the natural decline in fertility with age in women. Data for points 1 to 3 were obtained from Italian institutional websites, while points 4 and 5 were estimated from scientific literature. Normalized estimates of cumulative pregnancy rates and live birth rates in Italian non-endometriotic and endometriotic women were calculated based on Italian family planning behaviour and endometriosis medical care issues. These estimates were combined and plotted by female aging to observe trends. MAIN OUTCOME MEASURES: age-specific fertility trends in endometriotic and non-endometriotic Italian women. RESULTS: treated endometriotic patients show a reduction in fertility potential compared to non-endometriotic and untreated endometriotic patients. CONCLUSIONS: the decline of fertility in Italian endometriotic women is mainly iatrogenic. Women with endometriosis should consider conceiving at a young age.