Surgical management of pain and infertility secondary to endometriosis.

The management of pain and infertility secondary to endometriosis remains a challenge. Surgical management of early-stage endometriosis-associated infertility has only a mild effect with a number needed to treat of at least 12 to achieve one pregnancy. Excision of endometriomas provides the best outcome for fertility and pain; however, there is a potential to reduce the ovarian reserve. Pain relief is seen in most patients undergoing surgical management but with a high recurrence rate over time. Long-term postoperative medical suppressive therapy with oral contraceptives may have some benefit in reducing recurrence of symptoms. Hysterectomy is effective in the long-term management of chronic pain associated with endometriosis.