Association of Clinical Features of Endometriosis with the Laparoscopic Staging of the Disease among Infertile Women

Open Access

Abstract

Background: Endometriosis is a common gynecologic disorder that frequently contributes to infertility. While clinical symptoms often guide initial assessment, their correlation with disease severity remains unclear. This study aimed to evaluate the association between clinical features and laparoscopic staging of endometriosis among infertile women. Methods & Materials: A cross-sectional observational study was conducted at BIRDEM General Hospital-2, Dhaka, from July 2017 to June 2018. A total of 100 infertile women undergoing diagnostic laparoscopy for suspected endometriosis were enrolled. Clinical symptoms (dysmenorrhea, dyspareunia, chronic pelvic pain, menorrhagia, dyschezia, urinary symptoms) and pervaginal examination findings (tenderness, nodularity, fullness, restricted uterine mobility, chocolate cysts) were recorded. Laparoscopic staging was performed according to the revised American Society for Reproductive Medicine (r-ASRM) classification. Associations were analyzed using Chi-square or Fisher’s exact tests, with p < 0.05 considered significant. Results: Endometriosis was diagnosed in 38% of participants, with Stage IV being most common (47.4%). Stage III and IV together accounted for 68.4% of cases. Severe dysmenorrhea (36.8%) was significantly associated with advanced stages (p = 0.016). Dyspareunia, chronic pelvic pain, menorrhagia, and dyschezia were more frequent in women with endometriosis but were not consistently predictive of disease stage. On pervaginal examination, tenderness (p = 0.019) and restricted uterine mobility (p = 0.020) were significantly associated with higher laparoscopic stages. Other findings, including nodularity, fullness, and chocolate cysts, were more common in advanced stages but did not reach statistical significance. Conclusion: Severe dysmenorrhea, pelvic tenderness, and restricted uterine mobility are key clinical indicators of advanced endometriosis in infertile women. While other symptoms may suggest the presence of disease, they are insufficient to predict severity. Careful clinical assessment can aid early identification and timely laparoscopic evaluation, potentially improving fertility outcomes.