[In Process Citation]

In a study 112 patients with histologically confirmed mostly recurrent endometriosis underwent a "three-step" therapy. Surgical removal of endometriosis implants was followed by a 6-months treatment with 3.75 mg of leuprorelin acetate depot as monthly subcutaneous injection and a second look laparoscopy with removal of residuals was performed. The follow-up period was up to 60 months (median 33.5 months). More than 50% of the patients had been pretreated by surgery and 30% by various medications. The r-AFS score pre- and postoperatively at the first- and post-therapeutic at the second look laparoscopy confirmed, that the primary operative intervention reduces the total r-AFS score by only 34%, whereas the combined approach reduces the score by 66%. These data of our own study could confirm, that in patients with symptomatic recurrent endometriosis the recurrence free time was dependent on the r-AFS score reached post-therapeutically and this holds true for all stages. The higher the posttherapeutic r-AFS score the shorter the interval to recurrence. 91/112 (83.3%) patients complained infertility. 43/91 (47.3%) became pregnant during the follow-up period resulting in 36 newborns. Conception was spontaneously in more than 50% and stimulation programs were necessary in the others. Quality of life was regained in 54.9% and improvement of subjective conditions were reported in 52.9%. In our study we could confirm a clear relationship of recurrence of symptomatic endometriosis to the posttherapeutically achieved r-AFS score. Early aggressive therapy of active endometriosis is the optimal prevention of infertility caused by endometriosis.