The role of the new reproductive technologies including IVF and GIFT in endometriosis.

In the context of the pathophysiology of endometriosis, the technology of IVF-ET and GIFT appears to offer a promising alternative for infertility associated with endometriosis in situations refractory to conventional medical or surgical therapy. The success rate of IVF with respect to follicular response, oocyte recovery, fertilization rate, and pregnancy rate in mild-to-moderate (stages I to II) disease is comparable to patients with tubal disease. However, compromise of oocyte recovery and fertilization appears to be present in severe-extensive cases (stages III to IV) implying an impairment of reproductive potential in advanced disease. In all stages of endometriosis, prior therapy, either medical or surgical, offers the best prognosis for an IVF or GIFT attempt. Surgical therapy with operative endoscopy at the time of oocyte retrieval offers a reasonable prognosis for treatment-independent pregnancy in cases of active endometriosis. The GIFT procedure bypasses an unfavorable peritoneal environment in stages I to II endometriosis without anatomic distortion or compromise of fallopian tube function. Pretreatment with GnRH analogues prior to ovulation induction is valuable in suppression of active disease as well as in inducing improved homogeneity of follicular response in IVF or GIFT cycles.