الفهرس 
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Abstract
Infertility is defined as t he inability to conceive
after one year of unprotected sexual intercourse of
reasonable frequency. If no apparent cause of infertility
could be elicited, it is then termed ”Unexplained
Infertility”.
Endometriosis is defined as the presence of
endometrium-like tissue outside the uterine cavity .
Several hypotheses have been proposed to explain
the development of endometriosis:
1. Retrograde menstruation
2. Coelomic metaplasia
3. Lymphatic and vascular embolism
However, other factors help to sustain the
continuity of this endometrium -like tissue in place.
These include hormonal and immunological factors. In
addition, there are several risk factors such as, familial,
genetic mutations, and environmental toxins.
The commonest symptoms of endometriosis are
infertility & subfertility, pelvic pain, dysmenorrehea,
dysparunia, dyschesia, & dysuria.
The diagnosis of endometriosis is made primarily
by history and clinical examination. Serum markers
such as CA-125 & CA19-9, though may be elevated in
endometriosis, yet are nonspecific for endometriosis.
Ultrasonography is deficient in the diagnosis of
endometrial nodules less than 20 mm. And in this field,
trans-rectal (and to a lesser extent trans -vaginal)
ultrasound is primarily used.
The golden standard for diagnosis of endometr iosis
however, is laparoscopy, w here the lesion could be seen
directly by visual inspection. However, laparoscopy is
expensive and needs high experience. In addition,
biopsies have to be taken fo r histopathological
confirmation.
This study was conducted on 203 patients, 95
patients were excluded as they had detectable causes of
infertility. This left us with 108 cases with infertility
undergoing diagnostic laparoscopy wit h no detectable
causes. The age of these patients ranged between 19-40
years with mean age 28 years and mean duration of
marriage 5.4 years.
Regarding the clinical aspect, dysmenorrhea &
dysparunia were positive indicators of endometriosis.
Also, presence of nodularity or tenderness during the
examination of Douglas pouch and /or utero-sacral
ligament, and fixation of the uterus were all positive
indicators of endometriosis.
Laparoscopic examination showed the presence of
endometrisosis in 28 cases (25.9%), the most affected
organs were the ovary (14 cases) , the utero-sacral
ligament and douglas pouch (17 cases) and peritoneal
adhesions (2 cases).
The severity and scoring of endometriosis were as
follow:
Grade I (minimal)[1-5]:17 cases
Grade II (mild)[6-15]: 1 case
Grade III (moderate) [16-40]: 10 cases
Statistical analysis showed significant correlation
between dysmenorrhea and dysparunia, and the
presence of endometriosis. The same was also true for
nodularity or tenderness in the Douglas pouch and /or
utero-sacral ligament.
However, there was no significant correlation
between endometriosis of the ovary and the previously
mentioned symptoms and signs. Yet, ovarian
endometriosis is an importa nt cause of infertility and
subfertility.
Thus, we can conclude that:
1. Clinical history and vaginal examination are important
indicators for the presence of endometriosis, and shouldn’t
be substituted by modern techniques of examination. Yet,
it should be mentioned that six of the cases with
endometriosis did not show any symptom or sign. Thus,
the presence of these symptoms and signs can indicate the
presence of endometriosis, but their absence does not
negate the presence of endometriosis.
2. Any degree of endometriosis, however low, may be
accompanied with infertility
. 3. Laparoscopy is considered the final and golden standard
test to diagnose endometriosis.
Finally, we recommend that:
This thesis was based on data collected from
cases of unexplained infertility who underwent
laparoscopy, without the pre sence of a control
group. This makes it a statistical analysis study
(descriptive study) . Also, the number of the cases
was small. So, another multi-centre study should
be performed including a control group of female
patients who underwent laparoscopy for causes,
other than unexplained infertility, and a larger
number of patients.