***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: STUDY OBJECTIVE To assess the efficacy of 13CO2 laser laparoscopy in treating infertile women with minimal to mild endometriosis according the American Fertility Society classification in terms of pregnancy rates . DESIGN Prospect i ve study . SETTING Medical school-affiliated hospital . PATIENTS One hundred seventy-six women whose infertility was associated with minimal or mild endometriosis diagnosed by laparoscopy . INTERVENTIONS The patients were treated with one of four methods : 49 underwent operative laparoscopy with newly developed 13CO2 laser vaporization and /or resection ; 45 were treated by operative laparoscopy with simple monopolar electrocoagulation ; 43 who had undergone only diagnostic laparoscopy did not receive any treatment ; and 39 received danazol 800 mg/day for 3 months after diagnostic laparoscopy . MEASUREMENTS AND MAIN RESULTS Estimated cumulative pregnancy rates using life table analyses were indicators of treatment of success and compared among the treatments . A subgroup of 111 patients considered to have endometriosis as the only major infertility factor were also evaluated and compared among treatment options . Pregnancy rates in the CO2 laser laparoscopy group were significantly higher than in the other three groups and in endometriosis-only subset . CONCLUSIONS Advanced laparoscopic surgery with the CO2 laser can be more efficient than other modalities in treating infertile women with minimal to mild endometriosis in terms of pregnancy rates . It appears that in experienced h and s , laser laparoscopy has more favorable results than the other treatments OBJECTIVE To determine pregnancy rates ( PR ) after fimbrioplasty and salpingostomy in nonocclusive distal tubal disease . To evaluate the relative impact of various factors using contemporary statistical analysis . DESIGN Prospect i ve cohort . SETTING Tertiary institutional infertility clinic . PATIENTS ( S ) Infertility patients . INTERVENTION(S ) Fimbrioplasty and salpingostomy . MAIN OUTCOME MEASURE(S ) Cumulative PR , monthly fecundity rates , monthly probability of pregnancy , crude PR , and cure rates . RESULTS ( S ) Thirty-five percent of patients conceived with a cure rate of 72.2 % , monthly probability of pregnancy of 3.9 % , and monthly fecundity rate of 3.9 % . Cumulative PRs were 22 % , 35 % , and 58 % at 6 , 12 , and 24 months , respectively . Pairwise comparisons ( unilateral , bilateral , or either ) failed to detect any statistical difference between the salpingostomy and fimbrioplasty groups . Salpingostomy patients initially may have a higher tendency to become pregnant but appear to lose that advantage after the first few months . When patients with tubo-ovarian adhesions are excluded from the analysis , patients who underwent a bilateral salpingostomy as their sole procedure had better outcome compared with those who only underwent bilateral fimbrioplasty . There was no significant association between pregnancy outcome and the presence of endometriosis , other infertility factors , or tubo-ovarian adhesions . The staging of adnexal adhesions and endometriosis did not predict pregnancy outcome . CONCLUSION ( S ) Laparoscopic fimbrioplasty and salpingostomy are clinical ly efficacious for the treatment of nonocclusive distal tubal disease . After accounting for statistical interactions of various factors among them , no particular association with pregnancy outcome could be identified . This illustrates the need for a revision of the classification of patients with distal tubal disease Minor degrees of endometriosis have often been regarded as being of no import and hence remain untreated , but a study of the natural history of endometriosis has demonstrated that 47 % ( 95 % confidence limits , 23–71 % ) of patients ( n=35 ) given  placebo in a double‐blind , r and omized controlled trial showed progression of the disease when assessed before and after treatment by laparoscopy . The active agent , the progestogen gestrinone , was given at a dose of 2.5 mg twice weekly and result ed in an improvement of the disease ( p < 0.004 ) . Furthermore , follow‐up over 12 months showed no significant difference between those patients treated with active agent or placebo , and none between those with persistent disease and those in whom it had been obliterated . These data suggest that a diagnosis of mild endometriosis should be followed by treatment to prevent progressive disease , but that the treatment does not influence subsequent fertility . They indicate that expectant treatment has no place and that even if fertility is not an immediate requirement , active treatment should be instituted , and that the new gestogen , gestrinone is efficacious . Other treatments , such as  danazol or luteinizing hormone releasing hormone ( LHRH ) agonists , or the older contraceptive or pseudopregnancy regimens , must be set against spontaneous improvement ( in 5 of 17 patients i.e. 29 % ) or elimination ( in 4 of 17 patients i.e. 24 % ) in the placebo group . Infertile patients with mild endometriosis  have disorders of follicular and luteal function , and in vitro fertilization suggests a reduced fertilization rate . Nevertheless , these patients require active treatment if these problems are not to be compounded by adhesions , possibly leading to ovarian enclosure , that would further reduce the untreated cumulative conception rate Minimal pelvic endometriosis can be the only pathology found in infertility patients undergoing an infertility work-up . Although the mechanism by which endometriosis causes infertility is not known , it is well established that pregnancy can be attained in many patients when this disease is treated . Three different modes of treatment were used in 167 infertility patients who had minimal pelvic endometriosis without other pelvic pathology . Group I ( danazol ) achieved 48.9 % pregnancy rates ( 23/47 ) , group II ( CO2 laser ) had 44.6 % pregnancy rates ( 37/83 ) , and group III ( CO2 laser and danazol ) achieved 51.4 % pregnancy rates ( 19/37 ) . Although the pregnancy rates in groups I and III were higher , they were not statistically significant when compared with group II Ninety infertility patients with moderate endometriosis were r and omized between laparoscopic electrocautery and 6 months of danazol therapy and studied for 7 months after treatment . Twenty of the 45 patients undergoing electrocautery conceived ( 44 % ) during the follow-up interval . Forty-one of the 45 patients in the danazol group completed the course of therapy , and 16 of those conceived ( 39 % ) during the same follow-up interval . There was no statistical difference between the two groups ( P less than 0.53 ) . No patients in the electrocautery group experienced complications . This demonstrates that electrocautery is safe and effective in the treatment of moderate endometriosis OBJECTIVE To assess the efficacy of laser laparoscopic surgery in the treatment of  pain associated with minimal , mild , and moderate endometriosis . DESIGN A prospect i ve , r and omized , double-blind , and controlled clinical study . SETTING Royal Surrey County Hospital , Guildford , United Kingdom , a referral center for the laser laparoscopic treatment of endometriosis . PATIENTS Sixty-three patients with pain ( dysmenorrhoea , pelvic pain , or dyspareunia ) and minimal to moderate endometriosis . INTERVENTIONS The patients were r and omized at the time of laparoscopy to laser ablation of endometriotic deposits and laparoscopic uterine nerve ablation or expectant management .  Pain symptoms were recorded subjectively and by visual analogue scale . The women were unaware of the treatment allocated as was the nurse who assessed them at 3 and 6 months after surgery . MAIN OUTCOME MEASURE Improvement or resolution of pain symptoms assessed subjectively and by visual analogue score . RESULTS Laser laparoscopy results in statistically significant pain relief compared with expectant management at 6 months after surgery . Sixty-two and a half percent of the lasered patients reported improvement or resolution of symptoms compared with 22.6 % in the expectant group . Results were poorest for minimal disease and , if patients with mild and moderate disease only are included , 73.7 % of patients achieved pain relief . There were no operative or laser complications . CONCLUSIONS Laser laparoscopy is a safe , simple , and effective treatment in alleviating pain symptoms in women with stages I , II , and III endometriosis OBJECTIVE To determine the efficacy of the endoscopic treatment of complete distal tubal occlusion or moderate to severe tubal phimosis and to analyze outcome using contemporary statistical method ologies . DESIGN Prospect i ve cohort analysis . SETTING Tertiary-care institution . PATIENTS One hundred thirteen consecutive patients undergoing a neosalpingostomy or salpingostomy .  INTERVENTIONS KTP/532 laser ( Laserscope , Santa Clara , CA ) laparoscopy . Additional infertility factors were treated postoperatively . MAIN OUTCOME MEASURES Crude pregnancy rate ( PR ) , monthly fecundity rate , monthly probability of pregnancy , cure rate , and cumulative PRs . Outcome was compared on the basis of the surgical procedure performed . The impact of endometriosis as well as other fertility factors was analyzed . RESULTS Twenty-three patients conceived yielding a crude PR of 20.4 % , a monthly fecundity rate of 2.6 % , a monthly probability of pregnancy of 6.4 % , and a cure rate of 52.4 % . There were six ectopic pregnancies ( 5.3 % ) . A significant difference was found among the cumulative pregnancy curves . The cumulative pregnancy curve for unilateral salpingostomy differed significantly from that of unilateral neosalpingostomy .  Patients with endometriosis and no other infertility factors had a significantly better cumulative pregnancy curve compared with patients without endometriosis or other factors as well as compared with patients with no endometriosis but with other infertility factors . Patients undergoing bilateral neosalpingostomy had a cure rate of 9.0 % whereas patients undergoing bilateral salpingostomy had a cure rate of 34.2 % . CONCLUSIONS Operative endoscopy yields PRs that are comparable to those reported in the literature for laparotomy . The presence of complete bilateral distal tubal occlusion has a negative impact on outcome In order to analyse the efficacy of resection/ablation of minimal/mild endometriotic lesions for improving fertility , we conducted a r and omized clinical trial . Eligible patients were women aged < /=36 years who were trying to conceive and had a laparoscopically confirmed diagnosis of minimal/mild endometriosis ( stage I or II of the revised American Fertility Society classification ) and otherwise unexplained infertility for > /=2 years . Eligible women were r and omly assigned to resection or ablation of visible endometriosis ( 54 patients ) or diagnostic laparoscopy only ( 47 patients ) . After laparoscopy women tried to conceive spontaneously for 1 year ( follow-up period ) . A total of five women withdrew from the study : three for personal reasons , and two were lost to follow-up . Considering 51 women in the resection/ablation and 45 in the no-treatment group who ended the follow-up period , 12 ( 24 % ) in the resection/ablation group and 13 ( 29 % ) in the no treatment group conceived ; the difference was not significant . Two spontaneous abortions were observed in the resection/ablation group and three in the no-treatment one . Thus the 1 year birth rate was 10 out of 51 women ( 19.6 % ) in the resection/ablation group and 10 out of 45 women ( 22.2 % ) in the no-treatment group . In conclusion , the results of this study do not support the hypothesis that ablation of endometriotic lesions markedly improves fertility rates BACKGROUND Minimal or mild endometriosis is frequently diagnosed in infertile women . It is often treated by resection or ablation of the lesions , but whether this improves fertility has not been established . We carried out a r and omized , controlled trial to determine whether laparoscopic surgery enhanced fecundity in infertile women with minimal or mild endometriosis . METHODS We studied 341 infertile women 20 to 39 years of age with minimal or mild endometriosis . During diagnostic laparoscopy the women were r and omly assigned to undergo resection or ablation of visible endometriosis or diagnostic laparoscopy only . They were followed for 36 weeks after the laparoscopy or , for those who became pregnant during that interval , for up to 20 weeks of pregnancy . RESULTS Among the 172 women who had resection or ablation of endometriosis , 50 became pregnant and had pregnancies that continued for 20 weeks or longer , as compared with 29 of the 169 women in the diagnostic-laparoscopy group ( cumulative probabilities , 30.7 percent and 17.7 percent , respectively ; P=0.006 by the log-rank test ) . The corresponding rates of fecundity were 4.7 and 2.4 per 100 person-months ( rate ratio , 1.9 ; 95 percent confidence interval , 1.2 to 3.1 ) . Fetal losses occurred in 20.6 percent of all the recognized pregnancies in the laparoscopic-surgery group and in 21.6 percent of all those in the diagnostic-laparoscopy group ( P=0. 
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The results still need to be interpreted with caution as Marcoux 1997 reported a large positive effect of surgery whereas Gruppo Italiano reported a small negative effect .
When considering fetal losses , meta- analysis did not demonstrate an effect of laparoscopic surgery when compared to diagnostic laparoscopy only .
The use of laparoscopic surgery in the treatment of subfertility related to minimal and mild endometriosis may improve future fertility