Conservative surgery for endometriosis in the infertile female: a study of 206 patients with implications for both medical and surgical therapy.

Two hundred and six women with endometriosis classified as mild (88), moderate (50), or severe (68) were evaluated after conservtive surgery. The duration of infertility was not related to the severity of the condition. In 137 patients, endometriosis was the only known cause of the infertility. Pregnancy rates in this group were 73.2%, 55.9%, and 40.4%, respectively, for patients with mild, moderate, and severe endometriosis. Of 56 patients with mild endometriosis (peritoneal involvement only), 78.0% had been infertile for 2 or more years; 73.2% became pregnant. These facts suggest that endometriosis, even in its mild form, does interfere with the conception process and that, in some way, surgery is efficacious. The surgery was most beneficial in the early postoperative period. Of patients who conceived, 30.5% did so within 3 months, 48.8% within 6 months, and 86.0% within 15 months after surgery. The data suggest that if medical suppressive therapy is to be used in conjunction with conservative surgery to enhance fertility, it should be used preoperatively rather than postoperatively.