Endometriosis and Infertility
Endometriosis may reflect one of the underlying factors of infertility. This estrogen-dependent disease affects up to 10% of reproductive-aged women and up to 50% of women with infertility. Infertility is a major cause of morbidity in women with endometriosis. Thirty to fifty percent of endometriosis pa- tients face infertility, and the condition reduces fecundity from 15% to 20% per month in healthy women to 2% to 5% per month in women with endometriosis. The exact cause of infer- tility is not definitively known, both pathologic and iatrogenic causes may exist. It has been hypothesized that several factors (anatomical, immunological, hormonal, genetic and environ- mental) may play a role in the pathogenesis of this chronic dis- ease. The first step towards an accurate and prompt diagnosis of endometriosis includes physical examination of the pelvis and the abdomen that are followed by the imaging techniques, namely transvaginal sonography, rectal endoscopic sonography and magnetic resonance imaging (MRI) , which are mainly em- ployed for infiltrating lesions as well as for the detection of a possible ovarian endometrioma. The ultimate diagnosis could be accomplished through the method of laparoscopy. Medical therapy can be helpful in managing symptoms, but does not im- prove pregnancy rates. The role of surgical treatment remains controversial. Superovulation with intrauterine insemination has shown modest improvement in pregnancy rates in women who may have endometriosis. The most effective treatment for endometriosis associated infertility is in-vitro fertilization. Re- cent focus on proteomics and genetics of the disease may aid in optimizing treatment options.