Individualized therapy of sterility caused by endometriosis

Abstract

In the case of infertility the macroscopically and/or histologically confirmed diagnosis of endometriosis alone is not an indication for surgical or medical treatment of endometriosis. Treatment is necessary only when additional clinical symptoms of pain caused by the disease, active proliferative implants, severe mechanical disturbances of Fallopian tubes and ovaries, or deep infiltration endometriosis is judged as a relevant cause of sterility. The presence of implants alone – especially in mild or minimal stages – is probably an accidental finding with no correlation to the infertility problems. The therapeutic options are surgical – mainly endoscopic surgery – medical or a combination of both. Regression of the implants and shrinkage of the cysts can be achieved with medically induced ovarian suppression. Clinical trials have demonstrated that high doses of progestins, Danazol and GnRH agonists are effective. Because low differentiated types of endometriosis and deep infiltration nodules can only be influenced with permanent estrogen deprivation, an endoscopic surgical procedure– resection, coagulation or vaporisation of endometriotic tissue, plus resection of adhesions and fibrosis – is the main therapeutic principle. Because microscopic implants and deep infiltration foci surrounded by fibrosis can not be treated sufficiently with endoscopic surgery alone, an individual therapeutic strategy must be adopted in each case of endometriosis and infertility. Taking in account the age of the patient, the duration of infertility, and other factors we have to consider medical and/or surgical treatment of endometriosis.