Management of endometriosis-associated infertility

The origin of the infertility associated with endometriosis has been reviewed in detail elsewhere in this issue (see the article by Pellicer). In patients with more advanced disease, anatomic distortion and pelvic adhesions may play a primary role. The pathogenesis of infertility in patients with minimal or mild endometriosis in the absence of mechanical distortion is more controversial. A host of alterations within the immunologic milieu of the peritoneal cavity creates a "hostile" environment for successful gamete interaction and early embryo development [1,2]. Other researchers have proposed that endometrial receptivity may be inhibited in patients with minimal or mild endometriosis and in otherwise unexplained infertility [3,4]. Several approaches have been used to achieve conception in this group of patients, with varying degrees of success (Box 1). In this article the authors critically review the data associated with each.