CO2 laser laparoscopy for the treatment of endometriosis associated with infertility.

Both medical and surgical therapy have been used in the treatment of infertility associated with endometriosis. Danazol has been used following screening laparoscopy to avoid the discomfort, expense and risk of laparotomy. The CO2 laser offers the advantage of precise excisional surgery at the initial laparoscopy and thus potentially avoids further surgery and the use of danazol. In 50 infertile women in whom initial or second-look laparoscopy revealed the presence of endometriosis, CO2 laser laparoscopy was used to excise (vaporize) the endometriotic lesions. At 7-19 months of follow-up, 11 patients had become pregnant. One pregnancy was ectopic, and one aborted. The estimated long-term pregnancy rate was 60% or greater. Of those who were not yet pregnant at this writing, 59% had either a cervical factor, male factor or both. There was a 70% decrease in the use of danazol for stage I endometriosis and a 78% decrease for stage II endometriosis without a decrease in the overall pregnancy rates when compared to those for previous therapy with laparoscopic coagulation. However, the highest pregnancy rates resulted from a combination of laparoscopic laser excision and danazol.