[Conservative treatment of endometriosis]

The patients with endometriosis have shown a significant increase in frequency in our country. In the recent years, the incidence of endometriosis in gynecological outpatients is probably 3%. In infertile patients, endometriosis has been demonstrated by laparoscopy in 20-30% of cases. The pregnancy rate of women with endometriosis has been noted to be 80-85% in the internal endometriosis and 50-60% in the external endometriosis. The risk of infertility is greater in women with external endometriosis than in women with internal endometriosis. The causes of infertility are multiple and additive. Mechanical interference with the reproductive function plays a predominant role. Pelvic adhesions involving ovaries and fallopian tubes interfere mechanically with ovulation, ovum pick-up and ovum transport. According to Brosens et al. the frequency of LUF syndrome is in excess of 79% in the patients with endometriosis. Another antifertility effect of endometriosis may involve coital avoidance due to dyspareunia, hyperprolactinemia, increased phagocytosis of spermatozoa and altered prostaglandin secretion in peritoneal fluid. Conservative treatment of endometriosis is associated with improvement infertility and the post-treatment pregnancy rate has become an acceptable indicator of the effectiveness of therapy. The choice of therapeutic approach depends on several factors including age of the patient, extent of the disease, extent and location of pelvic adhesions and other coexisting infertility factors. Several hormonal regimens have been recommended for the treatment of endometriosis. They include androgen, progestogens and pseudopregnancy, danazol-induced pseudomenopause, gestrinone and LH-RH agonists.(ABSTRACT TRUNCATED AT 250 WORDS)