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.

Parity and Subfertility Effects of Continuous Oral Contraceptives on Fertility Are Important

To the Editor:

In recent articles, Barnhart and colleagues present data on time to conception following discontinuation of continuous oral contraception (OC) (1). They compare these and other data and conclude that “the return of fertility in former OC users … is comparable to … other contraceptive methods” (2). While we are pleased to see the addition of empirical evidence to this debate, we have some concerns about the role of parity in the time to conception, and are concerned that an uncritical acceptance of this conclusion may cause harm.