title: The efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain.
abstract: This article is a review of the efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain. Endometriosis is the cause of pelvic pain (dysmenorrhea, dyspareunia) and infertility in more than 35% of women of reproductive age. 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; (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. Nevertheless, because the Canadian study reported a large number of cases, we strongly support the view that visible endometriosis must be removed at the time of surgery. In cases of moderate and severe endometriosis-associated infertility, the combined approach (operative laparoscopy with GnRH-a) 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 be undertaken first to give our patients the best chance of conceiving naturally.
authors.affiliation: Department of Gynecology, Université Catholique de Louvain, Cliniques Universitaites St-Luc, Brussels, Belgium. donnez@gyne.ucl.ac.be
authors.forename: Jaques
authors.initials: J
authors.lastname: Donnez
authors.forename: Jean
authors.initials: J
authors.lastname: Squifflet
authors.forename: Céline
authors.initials: C
authors.lastname: Pirard
authors.forename: Pascale
authors.initials: P
authors.lastname: Jadoul
authors.forename: Christine
authors.initials: C
authors.lastname: Wyns
authors.forename: Mireille
authors.initials: M
authors.lastname: Smets
mesh_terms: D004715:Endometriosis / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D017699:Pelvic Pain / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy