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In patients with clinically suspected mild endometriosis who have acceptable sperm quality, ovarian stimulation with clomiphene citrate and intrauterine insemination (IUI) for three to four cycles can be utilized for first line treatment. This chapter reviews options including observation, ovarian suppression, ovarian stimulation, surgery, and assisted reproductive technologies. The role of surgery in the treatment of endometriosis has historically been controversial. The first randomized controlled trial (RCT) that addressed the question of whether laparoscopic ablation of endometrial implants and adhesiolysis in patients with early stage endometriosis showed that treatment improved fertility compared to diagnostic laparoscopy alone. Although it is generally accepted that in vitro fertilization (IVF) improves pregnancy rates (PR) in patients with endometriosis versus expectant management, definitive data confirming this is available only from one small RCT. In patients with endometriosis, treatment with GnRHa for 3-6 months prior to IVF cycle start appears to increase ongoing PRs.
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