The value of two-step operative laparoscopy with interval pituitary suppression in the treatment of infertility caused by severe endometriosis.
OBJECTIVE
To appraise a new approach to laparoscopic surgery for infertility caused by advanced endometriosis.


RESULTS
Endometriosis is a common systemic and local disease with altered peritoneal function, which requires both systemic and local treatment. Medication alone cannot improve infertility, and laparoscopic treatment, particularly in severe endometriosis, has a high recurrence rate and is often limited by technical difficulties. Novel treatment strategies have therefore to be sought, especially in women who do not want in-vitro fertilization as a first option, either because they suffer from pain in addition to infertility or want to enhance their fertility over many cycles.


CONCLUSIONS
Two-step operative laparoscopy with interval pituitary suppression by means of gonadotrophin-releasing hormone analogues reduces the extent of endometriosis, as classified by the American Fertility Association, and appears to be a promising method of achieving optimal cytoreduction and facilitating complicated surgery in severe endometriosis, while protecting the ovary from unnecessary trauma. A large-scale well-designed study is needed to confirm that this treatment leads to improved pregnancy rates.
Ball
Elizabeth
E
The Centre for Reproductive Medicine and Surgery, Kenton and Lucas Wing, St Bartholomew's Hospital, London, UK.
Byrne
Hugh
H
Davis
Colin
C
D003131:Combined Modality Therapy; D004715:Endometriosis / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D016896:Treatment Outcome
D007987:Gonadotropin-Releasing Hormone