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Endometriosis and infertility: an integrated approach
Author(s) -
Ledger W.L
Publication year - 1999
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/s0020-7292(98)00240-9
Subject(s) - medicine , endometriosis , infertility , gynecology , obstetrics , pregnancy , genetics , biology
Objective : To define an integrated approach to endometriosis‐associated infertility. Methods : Review of published literature with grading of evidence by quality. Results : Laparoscopy remains the investigation of choice in cases of endometriosis‐associated infertility and allows the possibility of surgical ablation at diagnosis. This improves fertility in minimal/mild disease, whereas danazol therapy has no benefit. Both in vitro fertilization (IVF) and superovulation with intrauterine insemination improve fertility in mild/minimal disease. Neither surgery nor medical treatment have been shown to improve fertility in moderate/severe disease. IVF with prolonged pituitary down‐regulation produced by long‐acting gonadotropin‐releasing hormone agonists after surgical debulking offers the best hope in such cases. Conclusions : Endometriosis‐related infertility should be treated as rapidly as possible with thorough investigation and the minimum delay between diagnosis and therapy.