ABSTRACT
INTRODUCTION Endometriosis, as a clinical entity, has been recognized and intensely investigated for well over 100 years. Despite the accumulation of an enormous amount of information, uncertainty still exists regarding etiologies, clinical consequences, and treatment efficacy. e two most common complaints leading to a diagnosis of endometriosis are pelvic pain and infertility. e advancement of innovative medical and surgical approaches, such as gonadotropin-releasing hormone (GnRH) agonists and laparoscopically guided laser ablation, have proven quite eective at improving many of the symptoms associated with endometriosis. It does appear that assisted reproduction technology (ART) is becoming an indispensable asset in providing aected couples with viable pregnancies, and with the accumulation of randomized trials, the role of GnRH agonist and antagonist protocols is becoming clear.
ENDOMETRIOSIS AND INFERTILITY ere is little debate that the extensive anatomical distortion and tubal obstruction frequently attributed to severe endometriosis does impair fertility. Less clear is the reported association between minimal or mild endometriosis and infertility in the absence of any mechanical disruption. Although there is no conclusive evidence that minimal to moderate endometriosis actually causes infertility, several studies dating back to the 1930s have suggested that there is at least an association between the two (1). In the 1970s, three studies retrospectively compared the incidence of endometriosis in women undergoing laparoscopy for infertility or voluntary sterilization (2-4). e incidences of endometriosis ranged from 21% to 48% in infertile women, while endometriosis was noted in only 1.3%–5% of fertile women undergoing tubal ligation. More recent studies (5,6) including one prospective investigation (7) have demonstrated that among women undergoing insemination with donor sperm due to severe male factor infertility, those with coexisting endometriosis had markedly fewer conceptions per exposure than women who did not have the disease. Another recent prospective double-blind study (8), which looked specifically at women with mild endometriosis compared to women without endometriosis, was able to show a trend toward higher pregnancy rates in women without the disease. e results, however, did not reach statistical significance. is may be attributable to the fact that the number of patients enrolled did not meet the study’s power calculation.
