Abstract
The treatment of endometriosis focuses upon two main goals: the reduction of pain and the therapy of infertility. The treatment of pain associated with endometriosis has been well investigated. All major medical therapies proved to be better than placebo treatment. Comparing progesterone, oral contraceptives, GnRH analogs and danazol, no single treatment modality seems to be superior to the others. A marked reduction of endometriosis-associated pain can also be reached by the insertion of a levonorgestrel-releasing intrauterine system. A surgical procedure seems to be effective for the treatment of pain; however, the rate of recurrence is high. Other patients suffer from pain as a consequence of postoperative adhesion formation. The treatment of endometriosis-associated infertility is debated in the international literature: most authors reported that medical treatment does not improve fertility in endometriosis patients. In addition, however, new studies demonstrated the benefit of GnRH analogs for 3 to 6 months after surgery for the outcome of ART. The fertility of endometriosis patients can be improved by surgical procedures in severe endometriosis. The methods of assisted reproduction with ovarian stimulation, intrauterine insemination or IVF are successful, but to a lower extent compared to infertile patients without endometriosis. Especially for endometriosis patients, IVF has higher success rates compared to insemination. The affected patient and her physician should discuss possible treatment options and chose the therapy which improves her complaints, keeping in mind her reproductive wishes. In addition, we describe several innovative, not yet established, approaches in endometriosis treatment.
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