Endometriosis

When endometriosis involves the ovaries and causes adhesions that block tubal motility and pickup of the egg, there is no question of its role in causing mechanical interference with fertility. Less secure is the information on the role of peritoneal endometriosis on fertility. Many physicians believe that even minimal endometriosis can cause infertility, impairing tubal function or gamete quality. This argument has been weakened by a failure to find benefit from medical treatment of infertility associated with minimal to mild endometriosis.

The absence of benefit from therapy, however, could represent a problem with the treatment rather than a lack of association between infertility and endometriosis. Endometriosis diagnosed by laparoscopy is reported in a higher proportion of infertile women (38.5%0 compared with fertile women (5.2%). Moreover, fecundity rates in women with endometriosis tend to be lower than the normal fecundity rate. However, the long-term cumulative pregnancy rates are very high in women who have minimal to mild endometriosis and are not treated.

The question of how minimal or mild endometriosis can affect fertility now has been superseded by the question of whether there is any effect of mild endometriosis on fertility. More importantly, should endometriosis be treated if the complaint is infertility and not pain? Many articles purporting to show that therapy overcomes endometriosis associated infertility are flawed by lack of control groups and its failure to use life-table analyses. Moreover, expectant management of mild endometriosis is rewarded with reasonable pregnancy rates that are comparable to those obtained with treatment. A cumulative pregnancy rate after 5 years of 90% has been reported in women not treated for minimal or mild endometriosis. (Source: Clinical Gynecologic Endocrinology and Infertility. Speroff, Glass, and Kase. Lippincott Williams & Wilkins. 1999)