Evidence linked treatment for endometriosis-associated infertility

Endometriosis – defined as the presence of tissue similar to endometrium outside the uterine cavity, is commonly associated with infertility. The true prevalence remains obscure due to overall lack of well-designed epidemiologic studies. The disease has an enigmatic and multifaceted pathology which remains elusive despite decades of investigation. Despite all the uncertainties, it is established that treatment of endometriosis can improve fertility in some cases. Medical therapy although useful in reducing the severity of other symptoms of endometriosis such as pain and menstrual disorders, is not efficacious to improve fertility. Laparoscopic surgery apart from establishing the diagnosis, appears to be superior to expectant management or medical therapy. Controlled ovarian stimulation with intrauterine insemination is recommended in early stage and surgically corrected endometriosis when pelvic anatomy is normal. In advanced cases or moderate disease with associated tubal or male factors, in vitro fertilization is a treatment of choice. Despite all treatments, pregnancy rates remain lower in these women compared to disease-free controls. Further well structured randomized clinical trials are necessary to reach any conclusive answers.