Endometriosis and infertility: a review.

The objective of this article is to review the current understanding of the relationship between endometriosis and infertility and the recommended management based on the latest evidence. The article is based on a MEDLINE search and bibliography review of the relevant literature from 1960 to 2003. The exact nature of the relationship between endometriosis and infertility remains uncertain. Surgical treatment of moderate and severe endometriosis improves the monthly fecundity rate. Surgical ablation of minimal and mild endometriosis seems superior to expectant management. Infertile patients with minimal and mild endometriosis can benefit from using clomiphene citrate and intrauterine insemination (IUI) or gonadotropins and IUI. Ovarian suppression should not be used in asymptomatic patients wishing to become pregnant except in the setting of in vitro fertilization and embryo transfer (IVF/ET). Prolonged suppression with gonadotropic-releasing hormone analogues should be considered for endometriosis patients about to undergo an IVF/ET cycle. IVF seems to be effective in endometriosis patients.