Comparison of Different Treatment Modalities of Endometriosis in Infertile Women

ABSTRACTSOver the past three decades, medical management of endometriosis has included high-dose synthetic estrogen, diethylstilbestrol, androgens, progestins (with or without estrogen), danazol, a synthetic derivative of 17-ethinyl testosterone, and expectant management. With the exception of the last named, each of these therapies has been associated with untoward side effects, vagaries of optimal dosage, and questionable effectiveness with regard to restoration of fertility. In the present article, the authors report their experience with three modes of therapy for mild endometriosis associated with infertility and draw tentative conclusions about the management of these conditions.One hundred and forty-four patients who were investigated for infertility and found to have laparoscopically confirmed mild to moderate endometriosis (stage I or II) were included in the study. They were divided into three treatment groups1) no treatment (controls) (N = 56); 2) medroxyprogesterone acetate (MPA), 10 mg three times a day orally for 90 days (N = 36); and 3) danazol for 6 months (N = 52). Danazol was given in a dose of 600 mg a day orally and increased to 800 mg if breakthrough bleeding occurred or pelvic pain persisted. After therapy, patients were followed for a minimum of 30 months. During this period, other infertility factors were treated if present. There were no significant differences in mean age or duration of infertility among the three groups. The maximum cumulative pregnancy rate was reached at 30 months and was higher for the medroxyprogesterone acetate group than for the danazol or control group, but the differences were not significant.Because infertility is multifactorial, the frequency of other problems that were present and corrected, such as male factors and cervical and ovulatory disorders, were compared also. The presence of other infertility factors was not significantly different among the three treatment groups. The presence of corrected confounding factors and ovulatory disorders did not appear to influence the rate of pregnancy.Figure 1 illustrates the life-table analysis of all three treatment regimens. The cumulative pregnancy rate reached a plateau at 30 months. At that time, it was 71 per cent for the medroxyprogesterone acetate group, 46 per cent for the danazol group, and 55 per cent for the controls. The mean conception rate per month of exposure to pregnancy was 3.6 per cent for the medroxyprogesterone acetate group, 3.4 per cent