High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners

To the Editor:

We read the article by Meuleman et al. (1) with interest. The high incidence of endometriosis (47%) and other pelvic pathology (29%) in this cohort makes a strong case for offering laparoscopy and hysteroscopy to couples with “unexplained infertility” (a diagnosis of exclusion). This diagnosis however requires confirmation of tubal integrity, and the issue is whether laparoscopy should be the first-line investigation to establish tubal patency. The authors did not say how many women in their cohort had a completely normal pelvis following laparoscopy and hysteroscopy.

The endometriosis-ovarian cancer connection: the case against preventive surgery/CA-125 as a biomarker for malignant transformation of endometriosis

To the Editor:

In their informative review on the relationship between endometriosis and ovarian malignancy (1), Nezhat and co-workers conclude that, given “the strong relationship between endometriosis and ovarian cancer […], appropriate and timely resection and elimination of disease should be practiced.”