Endometriosis and subfertility

Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which responds to menstrual cycle changes and induces a chronic inflammatory reaction. It has been one of the most common gynecological disorders in women of childbearing age, and up to 50% of women with endometriosis have been associated with subfertility. The medical management of symptoms of endometriosis delays the chances of conception, whereas surgical interventions for advanced endometriosis with associated pelvic adhesions have been found to improve chances of pregnancy. Therefore, to meet the complex needs of a woman with endometriosis desirous of fertility, a multidisciplinary team along with a focal fertility specialist is needed to assess her for individual needs. Surgical management options play in, where medical therapies are ineffective. Hence, hormonal treatment to women wishing to conceive should not be offered. Instead, they need to be offered excision or ablation plus adhesion lysis of endometriosis if there are no adhesions. Laparoscopic ovarian cystectomy should be considered for endometriomas. The choice between laparoscopic and open surgery should be considered carefully in women who have endometriomas with adhesions. The benefits and risks of superovulation/intrauterine insemination or assisted reproductive technique-embryo transfer vs repeat surgery should be well thought-out for these women, especially if these endometriomas are small. Raising awareness along with long-term support is the key to improve compliance in endometriosis treatment.