Ledger W L
Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford, UK.
Int J Gynaecol Obstet. 1999 Feb;64 Suppl 1:S33-40. doi: 10.1016/s0020-7292(98)00240-9.
To define an integrated approach to endometriosis-associated infertility.
Review of published literature with grading of evidence by quality.
Laparoscopy remains the investigation of choice in cases of endometriosis-associated infertility and allows the possibility of surgical ablation at diagnosis. This improves fertility in minimal/mild disease, whereas danazol therapy has no benefit. Both in vitro fertilization (IVF) and superovulation with intrauterine insemination improve fertility in mild/minimal disease. Neither surgery nor medical treatment have been shown to improve fertility in moderate/severe disease. IVF with prolonged pituitary down-regulation produced by long-acting gonadotropin-releasing hormone agonists after surgical debulking offers the best hope in such cases.
Endometriosis-related infertility should be treated as rapidly as possible with thorough investigation and the minimum delay between diagnosis and therapy.
确定一种针对子宫内膜异位症相关性不孕的综合治疗方法。
回顾已发表的文献，并根据质量对证据进行分级。
腹腔镜检查仍是子宫内膜异位症相关性不孕病例的首选检查方法，并且在诊断时有可能进行手术切除。这可提高轻度/微小病变患者的生育能力，而达那唑治疗则无益处。体外受精（IVF）和超排卵联合宫腔内人工授精均可提高轻度/微小病变患者的生育能力。手术和药物治疗均未显示可提高中度/重度病变患者的生育能力。在手术减瘤后，使用长效促性腺激素释放激素激动剂进行长期垂体降调节的IVF在此类病例中提供了最大的希望。
子宫内膜异位症相关性不孕应尽快进行全面检查，并在诊断和治疗之间尽量减少延迟。
