A proposed classification of pelvic endometriosis.

The correlation between extent of endometriosis and pregnancy rate was analyzed in a study of 107 infertile women who underwent conservative operative treatment for pelvic endometriosis. The diagnosis was established or suspected on the basis of history and physical examination in 84.1% of cases. Endometrial involvement was classified as mild moderate or severe. Major factors considered in developing this classification scheme included extension and size of the lesion scarring and retraction of the tissue involved pelvic and peritubular adhesions and significant bowel or urinary tract involvement. Presacral neurectomy removal of endometrial implants plication of the uterosacral ligaments and uterine suspension were performed in all cases. Overall 49 of the 107 women (45.7%) became pregnant following surgery. The pregnancy rate declined with the length of infertility with the highest rate (57.1%) found among women whose infertility had been 1-2 years in duration. Patients age which ranged from 20-39 years was not significantly related to achievement of pregnancy. 40.7% and 61.5% pregnancy rates were observed among women with primary and secondary infertility respectively. 35 of the 49 pregnancies were achieved during the 1st year after surgery. 48.5% of women with ovarian implants became pregnant. A 45% rate was achieved in the group of women who showed involvement of the cul-de-sac bladder peritoneum uterosacral ligaments and 1 or both ovaries. 8 patients were classified as having mild endometriosis and 6 (75%) became pregnant. 60 were classified as having moderate endometriosis and 30 (50%) became pregnant. Of the 39 cases classified as severe 13 (33.3%) became pregnant. These results suggest that the duration of infertility prior to surgery and the degree of endometrial involvement are central factors in the obstetric prognosis of patients undergoing conservative surgery for endometriosis. Further studies are being conduted to determine whether major health problems develop in women with endometriosis who do not have conservative surgery and/or never become pregnant.