Pre- and post-surgical management of endometriosis

The efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain is a source of questions and controversies. 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, and (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. In cases of moderate and severe endometriosis-associated infertility, the combined approach (operative laparoscopy with gonadotropin-releasing hormone agonist) 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 first be undertaken to give our patients the best chance of conceiving naturally. In cases of rectovaginal adenomyotic nodule, surgery must be considered as first-line therapy, medical therapy being relatively inefficacious.