Endometriosis and infertility: an integrated approach.
OBJECTIVE
To define an integrated approach to endometriosis-associated infertility.


METHODS
Review of published literature with grading of evidence by quality.


RESULTS
Laparoscopy remains the investigation of choice in cases of endometriosis-associated infertility and allows the possibility of surgical ablation at diagnosis. This improves fertility in minimal/mild disease, whereas danazol therapy has no benefit. Both in vitro fertilization (IVF) and superovulation with intrauterine insemination improve fertility in mild/minimal disease. Neither surgery nor medical treatment have been shown to improve fertility in moderate/severe disease. IVF with prolonged pituitary down-regulation produced by long-acting gonadotropin-releasing hormone agonists after surgical debulking offers the best hope in such cases.


CONCLUSIONS
Endometriosis-related infertility should be treated as rapidly as possible with thorough investigation and the minimum delay between diagnosis and therapy.
Ledger
W L
WL
Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, UK. wledger@radiusjr2.ox.ac.uk
D000328:Adult; D003613:Danazol / Q000627:therapeutic use; D004715:Endometriosis / Q000150:complications* / Q000628:therapy; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000628:therapy; D010535:Laparoscopy
D004965:Estrogen Antagonists; D007987:Gonadotropin-Releasing Hormone; D003613:Danazol