Endometriosis and infertility: an enigma.

In our efforts to overcome infertility and subjective complaints in young women with endometriosis, we have performed conservative surgical procedures upon 142 women 30 years of age or less. In these women, multiple endometriomata were resected from the pelvic peritoneum, one or both ovaries, the large and small bowel, and the appendix. In addition, uterine and ovarian suspension, bowel resection, appendectomy, myomectomy, and presacral neurectomy (PSN) were performed when indicated. Conception occurred in 70% of the women wishing to conceive; the highest rate was found among those who had developed endometriosis after a previous conception. Ovarian involvement seemed to reduce the conception rate by 10%. Uterine suspension and PSN did not affect conception but did provide a symptomatic relief. We conclude that early examination for endometriosis and aggressive surgical management is indicated in young women with demonstrable disease.