Endometriosis and its treatment

G. David Adamson, Wendy Shelly
In: The Subfertility Handbook · 2010 · pp. 176–184 · doi:10.1017/cbo9780511919244.017 · W2460450503
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⚙ AI-generated summary by claude@2026-06, 2026-06-12 ⓘ

This paper reviews in vitro fertilization as a treatment for subfertility caused by various factors, including endometriosis, and outlines the typical stages of an IVF cycle.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

This chapter from The Subfertility Handbook examines endometriosis-associated infertility, summarizing how endometriosis-related scarring and adhesions can anatomically distort pelvic structures and reduce pregnancy rates. It reviews diagnostic accuracy for deeply infiltrating endometriosis, noting that ultrasonography and MRI have variable sensitivity (33–83% depending on lesion location), while diagnostic laparoscopy or laparotomy is described as definitive. The chapter discusses treatment options including ovarian suppression with progestins, danazol, and gonadotropin-releasing hormone agonists, and also addresses surgery aimed at removing endometriosis lesions, with a caveat that anatomical distortion in more severe disease may limit surgical alternatives. This paper is centrally about endometriosis — specifically, endometriosis-associated infertility diagnosis and treatment strategies.

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Abstract

In vitro fertilization (IVF) and other assisted reproductive techniques are now fully accepted modalities of treatment for subfertility in our modern world. The indications for IVF have increased with the development of newer techniques such as ICSI, surgical sperm retrieval, embryo biopsy, and cryopreservation techniques, and IVF has become the cumulative step for the diagnosis and treatment for unexplained infertility. Certain indications for subfertility discussed in this chapter include tubal infertility, endometriosis, ovarian dysfunction, surrogacy, and male factor. The typical IVF cycle involves the following stages: stimulation for multiple follicular development, monitoring follicular growth and development, trigger of follicular maturation, oocyte recovery and identification, insemination/ICSI, embryo culture, embryo replacement, luteal phase support and confirmation of pregnancy. Traditionally, pregnancy rate per cycle has been used to compare results but gradually cumulative pregnancy outcome over the course of treatment may become more pertinent to the couple.
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The Subfertility Handbook Buy print or eBook [Opens in a new window] A Clinician's Guide - The Subfertility Handbook - The Subfertility Handbook - Copyright page - Contents - Foreword - Contributors - Chapter 1 Subfertility – a logical approach - Chapter 2 Pre-pregnancy counseling and treatment - Chapter 3 The first interview with a new couple - Chapter 4 Investigation of the female patient - Chapter 5 Assessment of the male partner - Chapter 6 Ultrasound in the investigation of the subfertile female - Chapter 7 Treatment options for male infertility - Chapter 8 The management of anovulation (including PCOS) - Chapter 9 The role of artificial insemination with partner semen in an ART program - Chapter 10 Early pregnancy loss - Chapter 11 In vitro fertilization: - Chapter 12 In vitro maturation - Chapter 13 The use of donor insemination - Chapter 14 Using donor oocytes - Chapter 15 Embryo donation: - Chapter 16 Endometriosis and its treatment - Chapter 17 The role of surgery in female subfertility - Chapter 18 Laboratory techniques in IVF - Chapter 19 Infertility counseling - Index Published online by Cambridge University Press: 06 December 2010 Edited by Book contents - The Subfertility Handbook - The Subfertility Handbook - Copyright page - Contents - Foreword - Contributors - Chapter 1 Subfertility – a logical approach - Chapter 2 Pre-pregnancy counseling and treatment - Chapter 3 The first interview with a new couple - Chapter 4 Investigation of the female patient - Chapter 5 Assessment of the male partner - Chapter 6 Ultrasound in the investigation of the subfertile female - Chapter 7 Treatment options for male infertility - Chapter 8 The management of anovulation (including PCOS) - Chapter 9 The role of artificial insemination with partner semen in an ART program - Chapter 10 Early pregnancy loss - Chapter 11 In vitro fertilization: - Chapter 12 In vitro maturation - Chapter 13 The use of donor insemination - Chapter 14 Using donor oocytes - Chapter 15 Embryo donation: - Chapter 16 Endometriosis and its treatment - Chapter 17 The role of surgery in female subfertility - Chapter 18 Laboratory techniques in IVF - Chapter 19 Infertility counseling - Index The anatomic distortion created by scarring and adhesions from endometriosis offers a clear mechanism for reduced pregnancy rates. Ultrasonography and MRI are of variable accuracy in diagnosing deeply infiltrating endometriosis, with sensitivity ranging between 33 and 83%, based on location of lesions. Diagnostic laparoscopy or laparotomy is the only definitive way to diagnose pelvic endometriosis. This chapter focuses on specific treatments available to patients with endometriosis-associated infertility. Ovarian suppression was long held as the standard in treatment of endometriosis-associated infertility. Methods of suppression included progestins, danazol, and gonadotropin-releasing hormone agonists. Surgery may also address other mechanisms by which endometriosis causes infertility by eliminating the endometriosis lesions. The anatomical distortion typically associated with more severe endometriosis would preclude this alternative in patients with moderate to severe disease. Overall, with appropriate diagnosis and the use of various treatments, the overall prognosis for pregnancy in women with endometriosis is very favorable. - Type - Chapter - Information - The Subfertility HandbookA Clinician's Guide, pp. 176 - 184Publisher: Cambridge University PressPrint publication year: 2010 Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Endometriosis and its treatment - - Book: The Subfertility Handbook - Online publication: 06 December 2010 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Endometriosis and its treatment - - Book: The Subfertility Handbook - Online publication: 06 December 2010 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive. - Endometriosis and its treatment - - Book: The Subfertility Handbook - Online publication: 06 December 2010

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endometriosisinfertility

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