Virtual Reality Game Preparation for Management of Anxiety in Children Scheduled for a Magnetic Resonance Imaging (IMAGINE): A Randomized Controlled Trial.

Endometriosis is a common, chronic inflammatory condition characterized by the presence of endometrium-like tissue outside of the uterus (, ). While it is estimated that approximately 10% of reproductive-aged individuals with a uterus are affected, many factors may lead to an underestimate of the true prevalence rates across different populations (, ). These include demographic, economic, or social barriers, such as stigma or lack of awareness (). Although patients can be asymptomatic, most patients present with pelvic pain, adnexal mass, or infertility (). Risk factors for endometriosis include low body mass index (BMI), alcohol use, smoking, mullerian anomalies, first-degree relative with endometriosis, and prolonged endogenous estrogen exposure as seen in early menarche, nulliparity, or short menstrual cycle interval (, , ). Greater parity and longer length of total breastfeeding have been shown to be protective factors (). In addition to increased risk of ovarian cancer and pregnancy complications, endometriosis has been increasingly recognized as a systemic condition with impacts on non-reproductive organs, hormone metabolism, cardiovascular disease, and autoimmune disorders (). Genetic factors have also been identified; one study of twins estimated the heritability of endometriosis to be around 50% (, ). The observed inheritance patterns suggest polygenic or multifactorial genetic factors, rather than a single gene mutation (). While a causal relationship between infertility and endometriosis has not been clearly established, the association between infertility and endometriosis is well known. Previous studies have suggested that 30-50% of patients with endometriosis have infertility, and 25-50% of patients with infertility have endometriosis (). Natural fecundity may decrease to 2-10% in couples with endometriosis (). There are several mechanisms that have been proposed to explain endometriosis-associated infertility. Patients with advanced stage endometriosis can have pelvic adhesions that block fallopian tubes, impair oocyte release from the ovary, or impede oocyte capture or transport (, ).