Comparison of different treatment modalities of endometriosis in infertile women

This study was designed to evaluate the effectiveness of three therapeutic modalities in the management of stage I and II endometriosis. Management modalities consisted of no treatment (controls, n = 56); oral medroxyprogesterone acetate (MPA), 30 mg orally per day for 90 days (n = 36); and danazol, 600 to 800 mg daily for 6 months (n = 52). All patients were followed for at least 18 months of exposure to pregnancy. Cumulative pregnancy rates were determined by life-table analysis. At 30 months, pregnancies resulted in 55% of group I (controls), 71% of group II (MPA), and 46% of group III (danazol). There were no significant differences among these rates. Similarly, there was no significant difference between the cumulative pregnancy rates for stage I (59%) and for stage II (57%). Abortion rates for the various treatment modalities were the following: MPA 6.3%, danazol 11%, and no treatment, 14.3%. The spontaneous abortion rate in stage I and stage II disease was not significantly different. The results of this study suggest that a period of expectant management with correction of other infertility factors may be warranted in patients with mild to moderate endometriosis before medical therapy is contemplated.