Incidence of Endometriosis in Symptomatic and Asymptomatic Cases of Primary Infertility in Tanta University Hospital

Background: Endometriosis is the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction. Some women with endometriosis experience painful symptoms and/or infertility, others have no symptoms at all. The aim of this study was to detect the incidence of endometriosis among symptomatic and asymptomatic cases of primary infertility in Tanta University Hospital over one year. Methods: This prospective observational study was conducted on 50 females aged between 20 and 35 years old, with unexplained infertility, symptoms of endometriosis and infertility for 1 or more years. Patients were divided into two equal groups: group (1):  cases with unexplained infertility for 1 year or more and group (2):  cases with symptoms of primary infertility and endometriosis for 1 year or more. Patients were subjected to the following: meticulous history taking (personal, obstetric and menstrual history, history of present illness, past history 'medical and surgical'), thorough clinical examination, routine laboratory investigations, imaging techniques (ultrasound and HSG) and laparoscopy for diagnosis of possible presence of endometriosis. Results: Endometrioma size was significantly higher in group 2 compared to group 1 (P value = 0.020). Stage 1 of endometriosis was significantly lower in group 2 compared to group 1 and Stage 2, 3 and 4 of endometriosis were significantly higher in group 2 compared to group 1 (P value = 0.04). Dysmenorrhea of endometriosis after treatment were significantly higher in group 2 compared to group 1(P value <0.001). Chronic pelvic pain was significantly higher in group 1 compared to group 2 (P value <0.001). Conclusions: The presence of dysmenorrhea, dyspareunia, pelvic pain, infertility, and clinical signs of cul-de-sac tenderness raise the suspicion of endometriosis in infertility patients.