Treatment of endometriosis-associated infertility based on evidence-based medicine

There is a well established association between endometriosis and infertility.The mechanism of infertility caused by endometriosis involves in multi-factors such as autoimmune,endocrine function,endometrial receptivity,pelvic anatomy and milieu interne etc.Current treatment of endometriosis-associated infertility aims to improve fecundity,e.g.removing or reducing ectopic endometrial implants,restoring normal pelvic anatomy and milieu interne and so on.There are several effective treatment options including expectant management,medical treatment,surgical treatment,surgery-associated medical treatment and assisted reproductive technology(ART)according to the specific condition of the patients.The optimal treatment for endometriosis-associated infertility is an individualized therapy which should be dependent on symptoms and signs,age,disease severity,fertility requirements,and up-to-date findings based on evidence-based medicine.For the patients with infertility caused by mild endometriosis,expectation treatment or medication therapy is a good option.The other treatment options should be considered when pregnancy is not successful after six months of expectant treatment or medication therapy.For the patients with moderate to severe endometriosis,surgery or laparoscopic surgery can be taken to restore pelvic anatomy,remove ectopic endometria,and improve pelvic environment.Finally,in vitro fertilization and embryo transfer(IVF-ET)can also be considered for the patients with moderate to severe endometriosis.For the patients with severe endometriosis,agood outcome could be obtained by choosing gonadotropin releasing hormone agonist(GnRH-a)therapy or IVFET directly.