The association of minimal and mild endometriosis without adhesions and infertility with therapeutic strategies

INTRODUCTION: Mild endometriosis may be present in fertile or infertile women. When present in infertile women it could be merely an innocent bystander, and some other problem is causing the difficulty in conceiving, or it may in some way be directly responsible for the infertility problem. Sometimes to achieve a pregnancy, only these other infertility factors need to be treated with no specific treatment for the endometriosis per se. However there are some data suggesting that sometimes treating the endometriosis surgically may be helpful. METHODS: The pregnancy outcome in women with probable endometriosis vs those without this entity (based on serum CA-125 levels) was compared with treatment rendered only to correcting ovulatory defects with no specific treatment rendered to the endometriotic lesions during the first six months of therapy. Another study evaluated the efficacy of laparoscopic removal of endometriosis vs leaving the lesions untouched on pregnancy outcome in women who failed to conceive after at least eight months of all infertility factors corrected. RESULTS: No differences in pregnancy outcome were found in women with probable endometriosis vs those without after six months of correcting ovulation defects. However, for the minority who did not conceive after such therapy, removing the endometriosis surgically significantly improved fertility rates in the next eight months. CONCLUSIONS: The probable presence of endometriosis based on symptoms, signs, or serologic evidence should prompt careful evaluation and treatment of subtle ovulatory problems, e.g., luteal phase defects and luteinized unruptured follicle syndrome. Therapeutic strategies for those women failing to conceive after six to eight months of conservative therapy could be laparoscopic removal of observed endometriotic implants or consideration of in vitro fertilization.