ABSTRACT
The efficacy of medical and surgical treatment of endometriosis-associated infertility
and pelvic pain is a source of questions and controversies. Complete resolution of
endometriosis is not yet possible, but therapy has essentially three main objectives:
(1) to reduce pain, (2) to increase the possibility of pregnancy, and (3) to delay
recurrence for as long as possible. It could be concluded that a consensus will probably
never be reached on minimal and mild endometriosis. In cases of moderate and severe
endometriosis-associated infertility, the combined approach (operative laparoscopy
with gonadotropin-releasing hormone agonist) must be considered as first-line treatment.
The mean pregnancy rate of 50% reported in the literature following surgery provides
scientific proof that operative treatment should first be undertaken to give our patients
the best chance of conceiving naturally. In cases of rectovaginal adenomyotic nodule,
surgery must be considered as first-line therapy, medical therapy being relatively
inefficacious.
KEYWORDS
Infertility - pelvic pain - endometriosis - ovarian endometriosis
