Olive David L, Lindheim Steven R, Pritts Elizabeth A
University of Wisconsin Hospital & Clinics, 600 Highland Avenue, H4-628, Madison, WI 53792, USA.
Curr Womens Health Rep. 2003 Oct;3(5):389-94.
Endometriosis and infertility have been linked in the discipline of gynecology for more than a century. There is evidence that endometriosis can and does decrease fertility. However, our ability to determine fertility prognosis based on a staging system is severely limited. Treatment options include medical therapy, surgical intervention, and assisted reproduction. For endometriosis-associated infertility, medical therapy seems to have no value alone. Surgical therapy is beneficial for all stages of diseases, as in assisted reproduction. The relative value of these two latter approaches, however, is untested. Our suggestions for the treatment of early-stage endometriosis are surgery and/or superovulation with intrauterine insemination as first-line treatments. For more advanced disease, with tubal damage, surgery or in vitro fertilization are options. For the most advanced cases, in vitro fertilization preceded by 3 months of medical treatment of the endometriosis is advised.
子宫内膜异位症与不孕症在妇科领域的关联已逾一个多世纪。有证据表明，子宫内膜异位症能够且确实会降低生育能力。然而，我们基于分期系统来确定生育预后的能力极为有限。治疗选择包括药物治疗、手术干预和辅助生殖。对于与子宫内膜异位症相关的不孕症，单纯药物治疗似乎并无价值。手术治疗对疾病的各个阶段均有益处，辅助生殖亦是如此。然而，后两种方法的相对价值尚未得到验证。我们对早期子宫内膜异位症治疗的建议是，将手术和/或通过宫内授精进行的超排卵作为一线治疗方法。对于病情更严重且伴有输卵管损伤的疾病，手术或体外受精是可选方案。对于最严重的病例，建议在进行体外受精前，先对子宫内膜异位症进行3个月的药物治疗。
