The current status of infertility associated with pelvic endometriosis.

As association between pelvic endometriosis and infertility has long been recognized. This discussion reviews the pathogenesis of endometriosis factors in associated infertility clinical features prevention and management (suppression of endometrial proliferationn surgical management and the results of treatment). Mild to moderate (uncomplicated) endometriosis is a common association with otherwise unexplained infertility. Careful clinical and laparoscopic assessment of infertile women will reveal the presence of emdometriosis which may otherwise be overlooked. Recent reports suggest that endometriosis may be the result of infertility rather than its cause or that the 2 may share a common etiology. Further studies are required to determine the pathophysiology of infertility associated with endometriosis. The importance of a detailed history and through clinical examination in the diagnosis of endometriosis cannot be overemphasized. The most common presentation with a history of progressive pelvic pain secondary dysmenorrhea and deep dyspareunia is frequently due to the presence of endometriomata in the Pouch of Douglas or in the uterosacral ligaments. Tender nodules may be felt on rectovaginal examination particularly when done around the time of menstruation. Some women with endometriosis may give a history of premenstrual spotting which may be a manifestation of ovarian dysfunction. Although absolute infertility is not the rule it may be the only complaint especially in women with uncomplicated endometriosis. Definitive diagnosis is only possible by direct observation of the lesions either during laparoscopy or at laparotomy. Radical surgery is only appropriate for women with extensive disease and those who are unconcerned about their future fertility. Conservative management is aimed at restoring fertility and ameliorating symptoms associated with endometriosis. The choice of treatment is between suppression of endometrial proliferation or its destruction by surgical resection or the diathermization of or a combination of these approaches. The outcome of various methods of treatment of mild or moderate endometriosis are summarized in a table but the relative efficacy of the treatment regimens cannot be validly assissed as classification of the severity of the disease and methods of calculating conception rates differ.