Medical versus surgical treatment of endometriosis

I believe that surgery is the treatment of choice for patients with endometriosis desiring pregnancy. An exception to this, in my opinion, is the patient with early endometriosis without significant ovarian enlargement or adhesions limiting tubal or ovarian mobility. In these cases, danazol therapy (discussed elsewhere in this symposium) appears to offer very good results. A report by Garcia and David that 65% of a group of 17 patients with minimal endometriosis conceived within 2 years without treatment questions the need for therapy in this group of patients. I believe therapy is indicated because of concern that the disease may progress in this period of watchful waiting and because of evidence that fertility rates decline both with duration of infertility and duration of disease. I believe a place remains for the use of progestin--estrogen pseudopregnancy in the treatment of early endometriosis without ovarian enlargement when the patient is single or does not desire to become pregnant in the near future. It is particularly indicated if the expense of danazol is prohibitive to the patient. It is not known as yet whether danazol over the long term will or will not provide a lower incidence of recurrence.