Endometriosis is a debilitating condition characterized by high recurrence rates. The etiology and pathogenesis remain unclear. Typically, endometriosis causes pain and infertility, although 20–25% of patients are asymptomatic. The principal aims of therapy include relief of symptoms, resolution of existing endometriotic implants, and prevention of new foci of ectopic endometrial tissue. Current therapeutic approaches are far from being curative; they focus on managing the clinical symptoms of the disease rather than fighting the disease. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. The benefits of these treatments have not been entirely demonstrated, particularly in terms of expectations that women hold for their own lives. Although theoretically advantageous, there is no evidence that a combination medical-surgical treatment significantly enhances fertility, and it may unnecessarily delay further fertility therapy. Randomized controlled trials are required to demonstrate the efficacy of different treatments.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Saridogan E, et al. ESHRE guideline on the diagnosis and management of endometriosis. Hum Reprod. 2005;20(10):2698–704.
Rock JA, Markham SM. Pathogenesis of endometriosis. Lancet. 1992;340:1264–7.
Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):789–99.
Counsellor VS. Endometriosis. A clinical and surgical review. Am J Obstet Gynecol. 1938;36:877.
Hummelshoj L, Prentice A, Groothuis P. Update on endometriosis. Womens Health (Lond Engl). 2006;2(1):53–6.
Simoens S, Hummelshoj L, D’Hooghe T. Endometriosis: cost estimates and methodological perspective. Hum Reprod Update. 2007;13:394–404.
Vercellini P, Trespidi L, De Giorgi O, Cortesi I, Parazzini F, Crosignani PG. Endometriosis and pelvic pain: relation to disease stage and localization. Fertil Steril. 1996;65:299–304.
Gruppo italiano per lo studio dell’endometriosi. Prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: results from a multicentric Italian study. Hum Reprod. 1994;9(6):1158–62.
Berube S, Marcoux S, Maheux R. Characteristics related to the prevalence of minimal or mild endometriosis in infertile women. Canadian Collaborative Group on Endometriosis. Epidemiology. 1998;9:504–10.
Vessey MP, Villard-Mackintosh L, Painter R. Epidemiology of endometriosis in women attending family planning clinics. BMJ. 1993;306:182–4.
ACOG Practice Bullettin No 51. Chronic pelvic pain. Obstet Gynecol. 2004;103(3):589–605.
Schwartz D, Mayaux MJ. Female fecundity as a function of age: results of artificial insemination in 2193 nulliparous women with azoospermic husbands. CECOS. N Engl J Med. 1982;306(7):404–6.
Hughes EG, Fedorkow DM, Cllins JA. A quantitative overview of controlled trials in endometriosis-associated infertility. Fertil Steril. 1993;59:963–70.
Collins JA, Burrows EA, Wilan AR. The prognosis for live birth among untreated infertile couples. Fertil Steril. 1995;64(1):22–8.
Verkauf BS. The incidence, symptoms, and signs of endometriosis in fertile and infertile women. J Fla Med Assoc. 1987;74(9):671–5.
Schenken RS, Asch RH, Williams RF, Hodgen GD. Etiology of infertility in monkeys with endometriosis: luteinized unruptured follicles, luteal phase defects, pelvic adhesions and spontaneous abortions. Fertil Steril. 1984;41:122–30.
Practice Committee of the American Society for Reproductive Medicine (ASRM). Endometriosis and Infertility. Fertil Steril. 2006;14:S156–60.
Suginami H, Yano K. An ovum capture inhibitor (OCI) in endometriosis peritoneal fluid: an OCI-related membrane responsible for fimbrial failure of ovum capture. Fertil Steril. 1988;50:648–53.
Bulletti C, Flamigni C, de Ziegler D. Implantation markers and endometriosis. Reprod Biomed Online. 2005;11(4):464–8.
Bulletti C, Flamigni C, de Ziegler D. Uterine contractility and embryo implantation. Curr Opin Obstet Gynecol. 2005;17(3):265–76. Corrected and republished in: Curr Opin Obstet Gynecol. 2006;18:473–84.
Kunz G, Deninger H, Wild L, Leyendecker G. The dynamic of rapid sperm transport through the female genital tract: evidence from vaginal sonography of uterine peristalsis and hysterosalpingoscintigraphy. Hum Reprod. 1996;11:627–32.
Bulletti C, Prefetto RA, Bazzocchi G, Romero R, Mimmi P, Flamigni C, et al. Electromechanical activities of human uteri during extra-corporeal perfusion with ovarian steroids. Hum Reprod. 1998;8:1558–63.
Bulletti C, de Ziegler D, Polli V, Diotallevi L, Del Ferro E, Flamigni C. Uterine contractility during menstrual cycle. Hum Reprod. 2000;15:81–9.
Ijland MM, Evers JL, Dunselman GA, Hoogland HJ. Endometrial wavelike activity, endometrial thickness, and ultrasound texture in controlled ovarian hyperstimulation cycles. Fertil Steril. 1998;70(2):279–83.
IJland MM, Evers JL, Dunselman GA, Volovics L, Hoogland HJ. Relation between endometrial wavelike activity and fecundability in spontaneous cycles. Fertil Steril. 1997;67(3):492–6.
Dawood MY. Dysmenorrhea. Clin Obstet Gynecol. 1990;33(1):168–78.
Ishimaru T, Masuzaki H. Peritoneal endometriosis: endometrial tissue implantation as its primary etiologic mechanism. Am J Obstet Gynecol. 1991;165:210–4.
Salamanca A, Beltran E. Subendometrial contractility in menstrual phase visualized by transvaginal sonography in patients with endometriosis. Fertil Steril. 1995;64:193–5.
Fanchin R, Righini C, Olivennes F. Uterine contractions at the time of embryo transfer alter pregnancy rates in in-vitro fertilization. Hum Reprod. 1998;13:1968–74.
Bulletti C, Dee Ziegler D, Polli V, Del Reffo F, Palini S, Flamini C. Characteristics of uterine contractility during menses in women with mild to moderate endometriosis. Fertil Steril. 2002;77(6):1156–61.
Bulletti C, De Ziegler D, Stefanetti M, Cicinelli E, Pelosi E, Flamigni C. Endometriosis: absence of recurrence in patients after endometrial ablation. Hum Reprod. 2001;16(12):2676–9. Erratum in: Hum Reprod 2002;17,844. Cincinelli E [corrected to Cicinelli E].
Huang HY. Medical treatment of endometriosis. Chang Gung Med J. 2008;31(5):431–40.
Redwine DB. Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis and reoperation and persistent or recurrent disease. Fertil Steril. 1991;56:628–34.
Chapron C, Dubuisson JB, Fritel X, Fernandez B, Poncelet C, Pinelli L, et al. Operative management of deep endometriosis infiltrating the uterosacral ligaments. J Am Assoc Gynecol Laparosc. 1999;6(1):31–7.
Sutton C, Hill D. Laser laparoscopy in the treatment of endometriosis. BJOG. 1990;97:181–5.
Donnez J, Nisolle M, Gillerot S, Smets M, Bassil S, Casanas-Roux F. Rectovaginal septum adenomyotic nodules: a series of 500 cases. Br J Obstet Gynaecol. 1997;104(9):1014–8.
Sutton CJ, Poley AS, Ewen SP, Haines P. Follow up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis. Fertil Steril. 1997;68:1070–4.
Davis GD. Management of endometriosis and its associated adhesions with the CO2 laser laparoscope. Obstet Gynecol. 1986;68(3):422–5.
Crosignani PG, Vercellini P, Biffignandi F, Costantini W, Cortesi I, Imparato E. Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis. Fertil Steril. 1996;66(5):706–11.
Bateman BG, Kolp LA, Mills S. Endoscopic versus laparotomy management for severe endometriosis. Fertil Steril. 1994;62:690–5.
Busacca M, Fedele L, Bianchi S, Candiani M, Agnoli B, Vignali M, et al. Surgical treatment of recurrent endometriosis: laparotomy versus laparoscopy. Hum Reprod. 1998;13:2271–4.
Practice Committee of the American Societ for Reproductive Medicine (ASRM). Treatment of pelvic pain associated with endometriosis. Fertil Steril. 2006;86(5):S18–27.
Marcoux S, Maheux R, Bérubé S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med. 1997;337(4):217–22.
Parazzini F. Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italian per lo Studio dell’Endometriosi. Hum Reprod. 1999;14(5):1332–4.
Adamson GD, Baker VL. Subfertility: causes, treatment and outcome. Best Pract Res Clin Obstet Gynaecol. 2003;17(2):169–85.
Aboulghar MA, Mansour RT, Serour GI, AI-Inany HG, Aboulghar MM. The outcome of in vitro fertilization in advanced endometriosis with previous surgery: a case-controlled study. Am J Obstet Gynecol. 2003;188(2):371–5.
Coccia ME, Rizzello F, Cammilli F, Bracco GL, Scarselli G. Endometriosis and infertility Surgery and ART: an integrated approach for successful management. Eur J Obstet Gynecol Reprod Biol. 2008;138(1):54–9. Epub 2008 Feb 20.
D’Hooghe T, Hummelshoj L. Multi-disciplinary centres/networks of excellence for endometriosis management and research: a proposal. Hum Reprod. 2006;21(11):2743–8.
Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman D, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698–704.
Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow D, Vandekerckhove P. Ovulation suppression for endometriosis (Cochrane Review). Cochrane Database Syst Rev. 2007;18(3):CD000155.
Jacobson TZ, Duffy JM, Barlow DH, Farquhar C, Koninckx PR, Olive D. Laparoscopic surgery for subfertility associated with endometriosis (Cochrane Review). Cochrane Database Syst Rev. 2010;20(1):CD001398.
Adamson GD, Hurd SJ, Pasta DJ, Rodriguez BD. Laparoscopic endometriosis treatment: is it better? Fertil Steril. 1993;59(1):35–44.
Guzick DS, Silliman NP, Adamson GD, Buttram-VC J, Canis M, Schenken RS, et al. Prediction of pregnancy in infertile women based on the American Society for Reproductive Medicine’s revised classification of endometriosis. Fertil Steril. 1997;67(5):822–9.
Osuga Y, Koga K, Tsutsumi O, Yano T, Maruyama M, Taketani Y, et al. Role of laparoscopy in the treatment of endometriosis-associated infertility. Gynecol Obstet Invest. 2002;53 Suppl 1:33–9.
Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril. 1998;70(6):1176–80.
Chapron C, Vercellini P, Barakat H, Vieira M, Dubuisson JB. Management of ovarian endometriomas. Hum Reprod Update. 2002;8(6):591–7.
Vercellini P, Chapron C, De Giorgi O, Consonni D, Frontino G, Crosignani PG. Coagulation or excision of ovarian endometriomas? Am J Obstet Gynecol. 2003;188(3):606–10.
Rickes D, Nickel I, Kropf S, Kleinstein J. Increased pregnancy rates after ultralong postoperative therapy with gonadotropin-releasing hormone analogs in patients with endometriosis. Fertil Steril. 2002;78(4):757–62.
Surrey ES, Silverberg KM, Surrey MW, Schoolcraft WB. Effect of prolonged gonadotropin-releasing hormone agonist therapy on the outcome of in vitro fertilization–embryo transfer in patients with endometriosis. Fertil Steril. 2002;78(4):699–704.
Garcia-Velasco JA, Somigliana E. Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod. 2009;24(3):496–501. Epub 2008 Dec 4.
Endometriosis has a profound impact on quality of life, and developing a therapy that also improves fertility remains a challenge for clinicians and basic scientists.
About this article
Cite this article
Bulletti, C., Coccia, M.E., Battistoni, S. et al. Endometriosis and infertility. J Assist Reprod Genet 27, 441–447 (2010). https://doi.org/10.1007/s10815-010-9436-1
- Uterine contractility