[A study on the diagnosis and treatment of the infertile patient with endometriosis externa by scoring]

Though the conservative treatment of infertility associated with endometriosis has undergone a significant evolution, clinical diagnostic problems still remain. In order to evaluate the efficacy and diagnostic value of the non-surgical scoring method, personal histories, symptoms, signs, hysterosalpingographic findings and routine infertility test results for 63 patients with endometriosis diagnosed laparoscopically were compared with those of 63 controls. 8 findings specific to endometriosis and the scores were as follows: Dysmenorrhea (1), dyspareunia (3), retroverted uterus (3), cul-de-sac nodularities (3), atonic (1) and marginal irregularity (1) of uterus, and perifimbrial adhesion (2) in hysterosalpingography, and unexplained infertility (2). The results obtained retrospectively revealed that the probability of endometriosis was seen in the cases in which the total scores ranged 0-4, 5-8, and 9-16; the incidence being approximately 10%, 60%, and 90% respectively. These results were confirmed by a prospective study. After completing a course of treatment, the pregnancy rate was 55% in patients with endometriosis. This fertility rate was higher than that of controls (23%). Thus, infertile women whose total scores ranged 0-4, 5-8, and 9-16 will be required to undergo re-examination of other sterility factors other than endometriosis, diagnostic laparoscopy and treatment for endometriosis, respectively.