Looking in Canada and abroad at some of the data we have, 40% of infertility patients have endometriosis. The endometriosis can be minimal, or it can be moderate. It's staged from one to four, and you can guess that four is the worst. If you have stage four with chocolate cysts, there's no question you need to have surgery, because it is often symptomatic.
However, there's an enigma. A patient can have terrible endometriosis with no symptoms—no pain or problem with periods. We just find the endometriosis. We've been trying to answer that question for a long time. I'm not sure if it's going to be easily answered, but we still need to know. What is that patient doing, within her body, so that she does not have the rigours of endometriosis?
Once you have endometriosis with infertility, you treat it the best way you can. Most people would like to give treatment a chance, but not right away. When you do the laparoscopy, you check for fertility. The uterus looks good. The tubes are open, because you can put dye through them. Even with a bit of endometriosis, within six months, you may be lucky enough to get pregnant. With moderate endometriosis, the same is true, so you don't want to rush into treatment. However, if there is terrible pain, without suppressing the hormones so that you are able to get pregnant, you then can go ahead.
It is individualized. Endometriosis is sometimes a little different for everyone. You specifically look at what the issues are: how much pain there is and whether there is a bleeding problem. You should treat a bleeding problem. With minor endometriosis, you complete the workup because.... Remember that 50% of the time men have a low sperm count. You need to look at the problem in a holistic fashion. Then, treat the endometriosis appropriately, individually. Infertility specialists are pretty good at laparoscopy. When they're making diagnoses, they can treat the endometriosis—do the laser and the buzz. Then, if there's a pregnancy, they say, “Oh, isn't that wonderful? That was because of the endometriosis.”