Pentoxifylline In a systematic review determining the effectiveness and safety of pentoxifylline, which has anti-inﬂammatory effects in the management of endometriosis in subfertile, premenopausal women, four trials involving 334 participants were included (427). Pentoxifylline had no significant effect on reduction in pain (one randomized trial, MD −1.60; 95% CI, −3.32–0.12), improvement of fertility (three randomized trials, OR 1.54; 95% CI, 0.89–2.66) or recurrence of endometriosis (one randomized trial, OR 0.88; 95% CI, 0.27–2.84) (427). No trials reported the effects of pentoxifylline on the odds of live birth rate per woman, improvement of endometriosis-related symptoms, or adverse events (427).
Peroxisome Proliferator Activated Receptor-γ Agonists Peroxisome proliferator activated receptor-γ (PPAR-γ ) agonists prevent and treat endometriosis in both rodent and baboon models for endometriosis and show promise for treatment of human endometriosis (152,153,428,429).
Many substances potentially capable of modulating immunologic or inﬂammatory mechanisms involved in the onset or progression of the disease could be the targets for future research in endometriosis (430,431). Preliminary trials with cyclooxygenase-2 (COX-2) inhibitors, leukotriene receptor antagonists, TNF-α inhibitors, antiangiogenic agents and kinase inhibitors show promising results in vitro in rodent and in nonhuman primate models, but their safety is an important issue regarding human use (432).
In China, treatment of endometriosis using herbal medicines is routine, and considerable research into the role of herbal medicines in alleviating pain, promoting fertility, and preventing relapse has occurred (433). A systematic review of the effectiveness and safety of herbal medicines in alleviating endometriosis-related pain and infertility, including two Chinese randomized trials involving 158 women, concluded that postsurgical administration of herbal medicines may have comparable benefits to hormonal treatment with gestrinone but with fewer side effects (433). Oral herbal medicines might have a better overall treatment effect than danazol; it could be more effective in relieving dysmenorrhea and shrinking adnexal masses when used in conjunction with an herbal enema (433). More rigorous research is required to accurately assess the potential role of herbal medicines in treating endometriosis (433).
Treatment of Endometriosis-Associated Subfertility
Surgical Treatment The treatment of endometriosis-related infertility is dependent on the age of the woman, the duration of infertility, the stage of endometriosis, the involvement of ovaries, tubes, or both in the endometriosis process, previous therapy, associated pain symptoms, and the priorities of the patient, taking into account her attitude toward the disease, the cost of treatment, her financial means, and the expected results. If surgery is performed and spontaneous pregnancy does not occur within 2 years of surgery, there is little chance of subsequent natural conception (434).
Surgery for Minimal to Mild Endometriosis