Overview of Pathogenesis, Symptoms, Diagnosis, Management, and Prognosis of Endometriosis and Its Role in Infertility

Affecting 10%–15% of all women of reproductive age, endometriosis is a disease conventionally thought to be comprised of endometrial glands and stroma located outside the uterus. The clinical presentation of endometriosis often varies, but the hallmark symptoms are chronic abdominal–pelvic pain, specifically painful menses, painful intercourse, painful urination, and painful defecation. Imaging can aid in diagnosis of deep infiltrating endometriosis, but the “gold standard” for diagnosing endometriosis is surgery. Approximately 30%–50% of women diagnosed with endometriosis also struggle with infertility. While the exact mechanism of how endometriosis plays a role in infertility has been elusive, some causes range from microscopic changes to anatomical changes such as scar and nodule formation. Use of primary surgery to resect or ablate endometriosis has nearly doubled live birth or ongoing pregnancy rates. However, despite undergoing surgery, one-fourth of women continue to have endometriosis-associated pain following the surgery, with more than 10% reporting no reduction of pain and an additional one-fifth of women undergoing further surgery. Additionally, the likelihood of recurrence at 3 years after surgical excision is 24%. This article presents an overview of endometriosis, pathogenesis, symptoms, diagnoses, management, and prognosis.