Conservative surgical treatment of endometriosis and infertility.

209 patients being investigated for infertility who were diagnosed by culdoscopy as having minimal, moderate, or severe endometriosis in the 5-year period ending in June 1977 participated in this evaluation of conservative surgical management. 125 of the patients were treated surgically by conservative excision of endometrial lesions, salpingo- and adnexo lysis and reconstructive tubal surgery when indicated. Ovarian suspension was employed in most cases to help restore optimal utero-ovarian relationships by plication of the ovarian ligament using A-O Vicril suture. Suppressive hormonal therapy was employed postoperatively only in patients whose endometriosis was too severe to permit adequate excision and where early recurrence seemed probable. 84 patients who had minimal disease not believed to affect their fertility or who refused surgery for a variety of reasons were not treated surgically. Among patients treated surgically, 27 of 36 with minimal disease, 27 of 61 with moderate disease, and 8 of 28 with severe disease were known to have become pregnant within a follow-up of at least 2 years. Of the 63 pregnancies, 12 were known to have miscarried. The total did not include 4 tubal pregnancies. Among those not treated surgically, 34 of 61 with minimal disease, 2 of 14 with moderate disease, and 0 of 9 with severe disease became pregnant within a follow-up of at least 2 years following initial diagnosis. The non-treated group is not comparable as it is overweighted with patients with minimal disease, and there was often another cause of infertility that made surgical intervention undesirable. 1 of 9 patients with a moderate degree of endometriosis treated by suppressive ovulation became pregnant.