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It has been estimated that about 5% to 10% of women of reproductive age have endometriosis - a condition in which pieces of tissue similiar to the tissue that lines the uterus, called the endometrium, grow in other areas of the body such as the ovaries, fallopian tubes, and the abdominal cavity. Although a direct cause and effect relationship between endometriosis and infertility has not been established, several theories have been proposed regarding the possible mechanisms whereby endometriosis may contribute to female infertility. Some of these theories include:

• Endometriosis may cause increased activity of certain immune cells such as monocytes and natural killer cells (NK cells) which, in turn, can lead to an inflammatory response resulting in infertility.
• Endometriosis may cause ovulatory dysfunction
• Endometriosis may interfere with sperm motility and fertilization
• Endometriosis may cause toxicity to the egg or embryo

The management of endometriosis must be individualized for each woman taking into account the woman's age, stage (severity) of the disease, and the duration of infertility. Treatment options for endometriosis include:

• Medical therapy with gonadotropin-releasing hormone (GnRH agonist medications prior to undergoing IVF.

• Surgical ablation of endometriosis which may be performed either as "open" surgery (laparoscopy) or "minimally-invasive surgery" (laparoscopic technique). Studies have shown that infertile women with mild to moderate endometriosis benefit from surgery and achieve higher pregnancy rates that women who do not undergo surgical treatment for endometriosis. The pregnancy rate for women with surgically-treated endometriosis is abut 40% higher than for women who undergo medical treatment for endometriosis.

• Controlled ovarian hyperstimulation - Infertile women with mild to moderate endometriosis may benefit from controlled ovarian stimulation with clomiphene citrate or gonadotropins when used in conjunction with intrauterine insemination. The most effective treatments for infertile women with severe endometriosis include surgical ablation or IVF/embryo transfer.