REVIEW – September 2008

Infertility due to endometriosis: there are yet no final answers


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The signs and symptoms of endometriosis are non-specific, and an acceptably accurate noninvasive diagnostic test has not yet been reported. Women with endometriosis typically present with pelvic pain, infertility or/and adnexal mass. Signs may be absent or may include tender nodules in the posterior vaginal fornix, tenderness of uterine motion, a fifed and retroverted uterus, or tender adnexal masses from endometriomas. The preferred method for the diagnosis is direct visualization of ectopic endometrial lesions (usually via laparoscopy) accompanied by histologic confirmation. Surgery for persistent adnexal masses may be indicated to remove an endometrioma or other pelvic pathology. Surgical or medical therapy is efficacious for pelvic pain due to endometriosis.
The association between endometriosis and infertility is complex. It involves impaired folliculogenesis, decreased fertilization, inflammatory factors in follicular, peritoneal and reproductive tract fluid, and implantation defects.
Treatment of endometriosis in the female partner of an infertile couple raises a number of complex clinical questions that do not have simple answers.