Endometriosis and infertility: what do we do for each stage?

Endometriosis and infertility have been linked in the discipline of gynecology for more than a century. There is evidence that endometriosis can and does decrease fertility. However, our ability to determine fertility prognosis based on a staging system is severely limited. Treatment options include medical therapy, surgical intervention, and assisted reproduction. For endometriosis-associated infertility, medical therapy seems to have no value alone. Surgical therapy is beneficial for all stages of diseases, as in assisted reproduction. The relative value of these two latter approaches, however, is untested. Our suggestions for the treatment of early-stage endometriosis are surgery and/or superovulation with intrauterine insemination as first-line treatments. For more advanced disease, with tubal damage, surgery or in vitro fertilization are options. For the most advanced cases, in vitro fertilization preceded by 3 months of medical treatment of the endometriosis is advised.