Management of Endometriosis—A Two Years Study at a Tertiary Care Center

ABSTRACT Objective The purpose of this study was to analyze the line of treatment and its outcome in cases of endometriosis presenting with infertility and pelvic pain at a tertiary center having facilities of operative endoscopy and assisted reproductive technology. Methods All cases of Infertility and pelvic pain over a period of two years were subjected to laparoscopy. Patients who were diagnosed with endometriosis were classified into categories. Different system of classification was used for patients of Infertility and pelvic pain. A large number of patients were subjected to expectant management. Selected cases underwent IUI, IVF-ET and ICSI. The numbers of pregnancies were recorded in these cases. Patients with pelvic pain were treated with hormonal therapy. Results 1038 patients were studied over a period of 2 years out of which 983 presented with Infertility and 55 with pelvic pain. 294 cases of infertility were detected and biopsy proven to be having endometriosis and 20 of the 55 cases of pelvic pain were also detected to have endometriosis. In the infertility group 76 patients were found to have bilateral tubal block. 215 patients were detected to have various grades of lesions but with patent bilateral/unilateral tubes. 6 patients with blocked tubes and 11 patients with patent tube/tubes also were associated with male factor infertility. 88 patients with blocked tubes and/or male factor received treatment with IVF-ET/ICSI. 178 patients underwent ovulation induction and 28 were simply observed. There were 42.8% pregnancies in the observation group, 49.4% in the ovulation induction-IUI group and 45.4% in IVF-ET/ICSI group. Conclusion 30% of the cases of Infertility had endometriosis. Following operative endoscopy treatment for all cases, the occurrence of pregnancy was similar in patients who were simply observed and those who received treatment with ovulation induction-IUI. Those with mechanical problems of sperm-egg union are best treated with IVF-ET where facilities exist.