Surgical Management Options for Patients with Infertility and Endometriosis

Aim: Endometriosis is an important cause of infertility. The disease is both diagnosed and treated surgically. Its pathogenesis is not entirely known; however, retrograde menstrual flow and a pro-inflammatory state in the peritoneum are thought to support its development. Many studies have been done to help better assess the effects of the disease on fertility rates and how surgical removal of disease can improve these fertility rates. The aim of this study was to review the current literature on the effects of endometriosis on infertility and the benefit of surgical treatment for these patients. Methods: Review of recent publications through Pubmed and the Cochrane data base. Results: The effects of minimal and mild disease on infertility are debatable, and studies have shown inconsistent results. Surgery through laparoscopic removal has been shown to be beneficial for women with moderate and severe endometriosis; however, those with severe disease may not benefit as much. Removal of ovarian endometriomas by an excisional process appears to be superior to fenestration and coagulation for spontaneous pregnancy outcomes. Conclusion: Laparoscopic removal of endometriosis is an important treatment option for patients with endometriosis-related infertility. Questions remain, however, and further research should be done on the effects of Stage I/II disease and bowel endometriosis on infertility.