Management of endometriosis and infertility following surgery

Endometriosis is almost always diagnosed at the time of surgery, usually by laparoscopy or laparotomy. Following surgery, further decisions must be made regarding management of the previously infertile patient who wishes to conceive. Management decisions are complex because of the variability of endometriosis presentation, concomitant disease, outcome of the surgery, other infertility factors, multiple treatment options, and, until recently, a paucity of good studies to inform us of the best treatments. It is not surprising that many clinicians have been confused by the possibilities, resulting in less than optimal care for their patients.1 However, current concepts increasingly based on reasonable data have resulted in a more evidence-based approach to treatment. Importantly, basic science initiatives should create better understanding and improved future management of this complex medical condition.2,3This chapter will present an approach to the postsurgery endometriosis infertility patient.