Management of infertility in women with endometriosis

Although there is confirmed an association between endometriosis and infertility, precise standards of managements have not yet been established. Ablation of endometriotic lesions plus adhesiolysis in minimal to mild endometriosis is more effective than diagnostic laparoscopy alone in improving fertility. Suppression of ovarian function and hormonal treatment alone are not effective in improving fertility. In women with stage I/II endometriosis associated infertility, expectant management or IUI after laparoscopy can be considered for younger patients. Women 35 years of age or older should be treated with IUI or IVF-ET. IVF pregnancy rate are lower in women with endometriosis than in those with tubal infertility. For women with stage III/IV endometriosis who fail to conceive following conservative surgery IVF-ET is should be offered.