Complications
The complications
of endometriosis include pain, fertility problems, and the risk of developing
ovarian cancer.
Endometriosis-Related Infertility
It is important to perform infertility evaluation to identify
potential causes in both partners. When developing a management plan, factors
such as the woman’s age, length of infertility, presence of pelvic pain, and
severity of endometriosis should be considered. For patients with significant
symptoms suggestive of endometriosis (eg pain, dysmenorrhea, dyspareunia) who
have not had primary surgical treatment, diagnostic and operative laparoscopy
with ablation or excision of endometriosis implants may be performed. For
patients who have undergone a primary surgical treatment of endometriosis, the
potential risks of major surgery must be weighed against the limited benefits
of another operative procedure as repeat surgical treatment does not improve
fertility. In women <35 years old with mild endometriosis (stage I/II),
expectant management (6 months of timed intercourse) or superovulation (SO)
with intrauterine insemination (IUI) can be considered. In women ≥35 years old,
more aggressive treatment such as SO/IUI or in vitro fertilization (IVF)
may be considered. Use of GnRH agonist for 3-6 months in IVF can increase
pregnancy rates. For patients with advanced endometriosis (stage III/IV), IVF
is an effective treatment option.