Part of “CHAPTER 98 – ENDOMETRIOSIS“

The most common medical problem caused by endometriosis is pelvic pain. The second most common problem caused by endometriosis is a decrease in fecundability. Fecundability is the chance of a couple conceiving during a single menstrual cycle. The fecundability of a normal, young (25 years of age) couple is ˜0.25. In couples with infertility and a female partner with early-stage endometriosis (stage I and II), the fecundability without treatment is ˜0.03 per cycle, a marked reduction from normal.42 In women with advanced endometriosis (stage III and IV), the fecundability is between 0.00 and 0.02. Surgical resection of endometriosis lesions in women with early-stage endometriosis has been demonstrated to increase fecundability from ˜0.02 to 0.04 per cycle.43 However, this requires general anesthesia and a major surgical procedure. An alternative to the surgical treatment of infertility associated with early-stage endometriosis is to empirically stimulate multifollicular development with clomiphene or gonadotropin therapy. When 40 women with infertility and stage I or II endometriosis were randomized to three treatment cycles of gonadotropin stimulation plus intrauterine insemination versus no treatment,44 the cycle fecundability was 0.15 in the gonadotropin treatment group and 0.04 in the group that received no treatment. The relative effectiveness of gonadotropin versus clomiphene stimulation of multifollicular development was studied in women who were randomized to receive (a) no treatment, (b) clomiphene stimulation, or (c) clomiphene plus gonadotropin stimulation.45 The cycle fecundability was 0.03 in the no treatment group, 0.07 in the clomiphene group, and 0.114 in the group receiving clomiphene plus gonadotropin. Both of these studies
demonstrate the effectiveness of empirical stimulation of multifollicular development in the treatment of infertility caused by endometriosis.