Infertility workup: identifying endometriosis

Modern-day imaging techniquesdultrasound and magnetic resonance imagingdwhen used with a systematic approach have offered a reliable replacement option for diagnosing endometriosis.
Infertility workup: identifying endometriosis

VOLUME 118, ISSUE 1, P29-33


Paul Pirtea, M.D., Nicolas Vulliemoz, M.D., Dominique de Ziegler, M.D., Jean Marc Ayoubi, M.D., Ph.D.


Endometriosis was classically diagnosed during diagnostic laparoscopies, which used to be routinely performed up until a decade ago or so. This practice fitted with the long-held belief that surgery was the gold standard for diagnosing endometriosis. Today, the abandon of routine diagnostic laparoscopies—in favor of assisted reproductive technology-first therapeutic approaches—has created a void for diagnosing endometriosis. Modern-day imaging techniques—ultrasound and magnetic resonance imaging—when used with a systematic approach have offered a reliable replacement option for diagnosing endometriosis. In infertility, endometriosis should be identified or excluded on the basis of past history or confirmation or exclusion suspicion on the basis of history and/or physical examination.

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Go to the profile of Pandiyan  Natarajan
about 1 month ago

Endometriosis and Infertility.

Endometriosis is a gynecological enigma. It masquerades in so many forms and is often diagnosed late in the course of the disease. Genetics and Immunology certainly play a role, but the precise role is not clear. However, Menstruation plays a far more definitive role. Retrograde Menstruation can explain all cases of Endometriosis in all sites. ( 1 ) Non menstruating women rarely, if ever develop Endometriosis. Endometriosis and Infertility are associated conditions with no clear causality established in either direction. The association is at best tenuous. 

Much emphasis has been laid on Early diagnosis of Endometriosis. However, it is not clear as to what could be achieved by Early Diagnosis. ( 2 ) Most of the patients present with the symptoms of Pelvic pain at or around Menstruation or Infertility. As there is no curative treatment, management is largely symptomatic. Surgical intervention is rarely required in Non porous women.

We strongly believe, based on several decades of observation that it is often Infertility which predisposes to Endometriosis. (3 ) The treatment of Endometriosis should focus on treatment of the presenting symptom, Pain and or Infertility. 

Medical  ( Hormonal ) management, ( other than pain killers, when absolutely necessary,)  delays attending to the underlying problem and does not alter the course of the disease. 

Surgical treatment, is rarely warranted in Infertile women,  except when it leads to obstructive symptoms. Surgery often  leads to compromised Ovarian Function and further worsens the Infertility. It should be undertaken only if absolutely necessary.


1.Etiology of Endometriosis- Simplified. 

Surya P, Pandiyan N.

2. Early Diagnosis of Endometriosis – Quo Vadis?
Pandiyan N, Surya P,  Shah Dupesh Khan , Radha Pandiyan

3. Infertility (Non Conception) with Regular Menstruation Predisposes to
Endometriosis – A Hypothesis
Pandiyan N, Surya P,  Radha Pandiyan

Professor Dr Pandiyan Natarajan,

Chief Consultant in Andrology and Reproductive Sciences,


Chettinad Super Speciality Hospital ( Retired )