397 - Endometriosis and adenomyosis: diagnosis, fertility, reproductive aging, & emerging treatments

Endometriosis affects ~10% of reproductive-age women globally, and 30–50% of infertile women have it; adenomyosis is even more common (20–30%) and frequently co-occurs, making it a critical, often missed, fertility disruptor.

The new March 2025 ACOG guideline allows clinical diagnosis of endometriosis based on symptoms (the '6 Ds') and empirical treatment, aiming to slash the typical 5–12 year diagnostic delay and prevent disease progression.

Age is the single biggest driver of a woman’s fertility decline: aneuploidy rates jump from ~35% at 30 to ~70% at 40, and egg freezing is most cost-effective in the early 30s—not 25—because 90% of women who freeze eggs never use them.

Adenomyosis-related IVF failure can often be reversed by suppressing the uterus with a GnRH agonist (e.g., leuprolide) for 2–4 months before embryo transfer, and a phase 3 biologic (HMI115, an anti-prolactin receptor antibody) may soon offer the first non-hormonal treatment for endometriosis.