Endometriosis and infertility: treatment is always necessary.

The incidence of endometriosis appears to be increasing, but is possibly due simply to the more widespread use of diagnostic laparoscopy. Whilst a clear pathogenetic role for endometriosis resulting in tubo-ovarian distortion and infertility is obvious, a causal role for mild endometriosis in infertility has not been established. Any one of several factors may result in both endometriosis and infertility. Nevertheless, endometriosis is best treated at the time of diagnosis in order to limit progression of the disease. The preferred method of treatment is medical, with surgery being reserved for those endometriotic lesions not responding to medical treatment. Conservative surgery will not eradicate microscopic foci, and it is possible that the surgery itself may result in adhesion formation. The choice of medication should be individualized, as the side-effects may not be readily tolerated by some women. Maintenance of amenorrhoea may not be essential to therapeutic efficacy, as normally sited and ectopically sited endometrial tissue may respond to hormonal manipulation in different ways.