Pre- and Post-Surgical Management of Endometriosis

Jacques Donnez, Céline Pirard, Mireille Smets, Pascale Jadoul, Jean Squifflet
Seminars in reproductive medicine · 2003 · vol. 21(2) , pp. 235–242 · doi:10.1055/s-2003-41329 · PMID:12917792 · W1790038092
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review explores the management of endometriosis-associated infertility and pelvic pain, concluding that combined surgical and medical approaches offer the best chance for pregnancy and pain reduction in moderate to severe cases.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper reviews the efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain, framing therapy around goals of pain reduction, improving pregnancy chances, and delaying recurrence. It argues that consensus may not emerge for minimal and mild endometriosis, but for moderate and severe endometriosis-associated infertility a combined approach using operative laparoscopy with gonadotropin-releasing hormone agonist should be considered first-line, citing literature with an overall mean post-surgery pregnancy rate of about 50%. For rectovaginal adenomyotic nodules, the paper states that surgery should be first-line because medical therapy is relatively ineffective. This paper is centrally about endometriosis — it focuses on pre- and post-surgical management strategies for endometriosis-related infertility and pelvic pain, with explicit discussion of rectovaginal “adenomyotic” nodules.

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Abstract

The efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain is a source of questions and controversies. Complete resolution of endometriosis is not yet possible, but therapy has essentially three main objectives: (1) to reduce pain, (2) to increase the possibility of pregnancy, and (3) to delay recurrence for as long as possible. It could be concluded that a consensus will probably never be reached on minimal and mild endometriosis. In cases of moderate and severe endometriosis-associated infertility, the combined approach (operative laparoscopy with gonadotropin-releasing hormone agonist) must be considered as first-line treatment. The mean pregnancy rate of 50% reported in the literature following surgery provides scientific proof that operative treatment should first be undertaken to give our patients the best chance of conceiving naturally. In cases of rectovaginal adenomyotic nodule, surgery must be considered as first-line therapy, medical therapy being relatively inefficacious.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Postoperative Care Preoperative Care Endometriosis Endometriosis Endometriosis Female Humans Infertility, Female Infertility, Female Recurrence Severity of Illness Index

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

Cited by (20)

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