Sometimes we strongly suspect that the disease is present based on the woman's history of very painful menstrual cycles, painful intercourse, etc., or based on the physical examination of the woman or ultrasound findings. The large majority of cases of endometriosis are mild. Although mild endometriosis is associated with infertility in some women, many fertile women also have mild endometriosis. A cause and effect relationship between mild endometriosis and infertility has not been established. It might be that infertility and delayed pregnancy predisposes women to developing endometriosis, rather than the endometriosis causing the infertility.
Severe endometriosis causes pelvic scarring and distortion of pelvic anatomy.
Any of these anatomic distortions can result in infertility. In some cases the eggs in the ovaries can be damaged, resulting in decreased ovarian reserve and reduced egg quality. Treatment of endometriosis Treatment for endometriosis associated with infertility needs to be individualized for each woman. There are no easy answers, and treatment decisions depend on factors such as the severity of the disease and its location in the pelvis, the age of the woman, length of infertility, and the presence of pain or other symptoms. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.