Mild and moderate endometriosis. Comparison of treatment modalities for infertile couples.
A series of 1,268 consecutive patients with stage I and II endometriosis (American Fertility Society classification) were treated for the disease. In 675, no other factors contributed to their infertility. Among these patients, with no problems other than mild endometriosis, 57% (16/28) became pregnant when treated expectantly, 54% (51/95) after being treated medically, 47% (9/19) after laparoscopic cautery treatment, 81% (147/181) after laparoscopic laser treatment and 84% (97/116) after conservative surgery (laparotomy). Statistical analysis of the pregnancy rates revealed no difference between expectant, medical and laparoscopic cautery treatment. No difference was noted between laparotomy and laser laparoscopy; however, there was a statistically significant difference between these treatments and expectant, medical and cautery treatment. Similar results were seen with stage II endometriosis in couples with no contributing factors other than endometriosis: 39% of patients (23/59) became pregnant after medical treatment, 70% (80/115) after laser laparoscopy and 74% (46/62) after undergoing major conservative treatment (laparotomy). A statistically significant difference between medical treatment and laparotomy as well as laser laparoscopy was noted. However, no such difference existed between laparotomy and laser laparoscopy. Therefore, it appears that in experienced hands the use of laser laparoscopy in stage I and II endometriosis is as successful as major surgery and statistically significantly better than expectant, medical and laparoscopic cautery treatment.