The patient with endometriosis: achieving pregnancy A Vodolazkaia and TM D’Hooghe

Introduction The aim of this chapter is to clarify the state of the art regarding the impact of endometriosis on fertility and to discuss the management of endometriosis associated with infertility.Background of endometriosisEndometriosis is an oestrogen-dependent, gynaecological disease, defined as the presence of endometrial-like cells outside the uterus.1 The condition is predominantly found in women of reproductive age, from all ethnic and social groups.1 The associated symptoms can impact on general physical, mental and social well-being.1 Endometriosis is associated with severe dysmenorrhoea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical or perimenstrual symptoms (e.g. bowel or bladder associated) with or without abnormal bleeding, infertility and chronic fatigue. Some affected women, however, remain asymptomatic.1,2 The prevalence of endometriosis in women with infertility and pelvic pain is about 30% and up to 50-60%, respectively.3