Endometriosis and gamete intrafallopian transfer

Endometriosis appears to be associated with infertility, but whether endometriosis is a cause, or merely a marker, of infertility remains to be determined. Given our rudimentary understanding of the pathogenesis of endometriosis and the complex processes mediating ovulation, fertilization, tubal transport, and implantation, therapeutic interventions have been empirical rather than targeted. Superovulation in conjunction with IUI, GIFT, and IVF/ET appears to be more efficacious than observation, medical management alone, or surgical ablation alone. Medical or surgical treatment alone have been demonstrated not to appreciably improve fecundity, although there may be a role for medical management prior to superovulation or ART. While the outcome for women with endometriosis who undergo GIFT may be impaired relative to women with unexplained infertility, at present GFT appears to be the most efficacious therapy for women with infertility associated with endometriosis. In the future, research directed at understanding the pathophysiology of endometriosis and infertility should yield novel and focused therapeutic approaches and improved outcomes.