How should the effectiveness of a specific treatment be measured?

When conservative surgery has been attempted, it has frequently required opening the abdomen and then burning, scraping, or cutting out the disease. Although there has been a glimmer of excellent pain relief reported in the literature following conservative surgery, success has still been measured mainly by pregnancy rates. Conservative surgery has been found to improve pregnancy rates, particularly for patients with a lot of scar tissue in the pelvis. Breaking up the scar tissue allows the pelvic organs to regain some of the natural mobility required for normal function.

Conservative surgery through the laparoscope has been accomplished by electrocautery, laser vaporization, sharp dissection, and electro-excision. The most meaningful follow-up to indicate successful treatment of endometriosis is the rate of discovery of biopsy-confirmed endometriosis at reoperation.

Infertility may not be caused by endometriosis at all, particularly in lower stages without a lot of adhesions, so studying fertility parameters after treatment of endometriosis is misleading. Pain is a more specific symptom of endometriosis than is infertility and if a symptom must be measured in order to gauge the effectiveness of a therapy, it should be pain relief, not infertility.