ENDOMETRIOSIS-ASSOCIATED INFERTILITY

Despite intense clinical interest and increasingly sophisticated diagnostic techniques, we know surprisingly little of the relationship between endometriosis and infertility or the mechanism of infertility in these couples. No therapy specifically directed toward the ectopic endometrial implants, medical or surgical, has been demonstrated to improve the likelihood of pregnancy for couples with endometriosis-associated infertility. This is consistent with the observation that, in the absence of mechanical distortion of the pelvic viscera, no therapy directed against the implants improves the likelihood of pregnancy in these couples. The reason for this lack of progress is most probably that the mechanism of infertility in these couples remains to be determined. At present, it would be more accurate to say that these couples have unexplained infertility. The most promising therapeutic approach is to treat women with endometriosis-associated infertility with a non-specific cycle fecundity enhancing technique. Typically this is one of the newer assisted reproductive technologies such as controlled ovarian hyperstimulation with intrauterine insemination of capacitated sperm. Since the fecundity of many of the women with endometriosis in the later reproductive years is rapidly declining, this may represent their most cost-effective option for establishing a pregnancy. Only with further effort directed towards determining the mechanisms of infertility in these couples will a more effective therapy be forthcoming. © 1993 Baillière Tindall. All rights reserved.