Pelvic endometriosis: infertility and pelvic pain

A multifactorial approach was used by the authors to analyze data from 119 women with endometriosis and infertility. Conservative surgical procedures afforded a mean pregnancy rate of 37.7 per cent for those women with significant disease. Only 6.7 per cent became pregnant when the proposed surgery was declined. There was an inverse relationship in severity of endometriotic involvement and pregnancy rate. The mean pregnancy rate among 17 patients with minimal disease for whom surgery was discouraged was 64.7 per cent; all pregnancies occurred within the first 2 years of follow-up. Relief of pelvic pain was dramatic, especially following presacral neurectomy. Laparoscopic selection of cases further reinforces the importance of grading severity of endometriosis prior to embarking on restorative surgery. Presacral neurectomy, despite reinforcement of pain relief, did not appear to contribute significantly to the occurrence of pregnancy.