LYCOS RETRIEVER 
Endometriosis: Infertility
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Women with endometriosis should be thought of as being "sub-fertile" and not "infertile". The monthly probability of conceiving in a natural cycle in women with endometriosis is about 3-4% as compared to 25% in a normal woman. With appropriate treatment, most women with endometriosis will be able to have a baby. Treatment of endometriosis-associated infertility depends on the extent of disease, age of the female and duration of her infertility. If surgical treatment fails to result in a pregnancy, empiric therapy with clomiphene and intrauterine inseminations (IUI) is started. If this is not successful, then gonadotropin/IUI’s are performed, followed by in vitro fertilization (IVF).
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Endometriosis affects women during their childbearing years. Endometriosis occurs in about 10 percent of women in this age group. Among women with infertility, the prevalence of endometriosis is higher, occurring in about 30 percent of infertile women.
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Other procedures may be used to determine the extent of endometriosis and follow its course, but their usefulness for diagnosis is limited. These tests include ultrasonography, x-rays taken after a barium enema, computed tomography (CT), and magnetic resonance imaging (MRI). Sometimes blood tests are done to measure levels of substances that increase when endometriosis is present. These substances (called markers) include cancer antigen 125 and antibodies to endometrial tissue. These markers cannot be used to confirm the diagnosis because they may be increased in several other disorders. Tests may be done to determine whether the endometriosis is affecting the woman's fertility (see Infertility: Diagnosis and Treatment).
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In the US: The incidence of endometriosis has not increased in the last 30 years. The prevalence is approximately 6-8% but estimates vary. It is usually diagnosed during laparoscopic surgery for evaluation of pelvic pain. Most prevalence studies are based on a surgical population in which the likelihood of disease is greater. Of the surgical population, endometriosis was diagnosed in 25% of women who had a laparoscopy for pelvic pain and in 20% of women who underwent surgery for infertility. No large-scale laparoscopic evaluation of asymptomatic women has been undertaken.
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Current estimates place the number of women with endometriosis at between 5% and 20% of women of reproductive age. About 30% to 40% of women with endometriosis are infertile, making it one of the leading causes of infertility. However, endometriosis-related infertility is often treated successfully with surgical destruction of the disease. Some women do not find out that they have endometriosis until they have trouble getting pregnant. While the presence of extensive endometriosis distorts pelvic anatomy and ... explains infertility, the relationship between early or mild endometriosis and infertility is less clear. The relationship between endometriosis and infertility is an active area of research.
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For women with severe endometriosis who want to become pregnant, conservative surgery (typically laparoscopy) is the appropriate approach for restoring fertility. Hormonal therapies that treat endometriosis itself, such as GnRH agonist or progestins, are generally considered not to help fertility. However, a 2002 study suggested that the use of the GnRH agonists after surgery helped improve conception rates in women who subsequently undergo assisted reproductive techniques (ART), such as in vitro fertilization (IVF). A 2006 study indicated that GnRH agonists given along with infertility treatments may help improve a woman's chance of becoming pregnant. This research is still preliminary.
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