Received December 06, 2016
Accepted April 07, 2017

Deep infiltrative endometriosis (DIE) can cause infertility and pelvic pain. Evidence of a clear connection between DIE and infertility is weak and it has not been possible to define the absolute benefit of the surgical treatment of DIE. The aim of this article is to review the current literature regarding the effect of operating DIE on fertility, pregnancy and IVF results. Clinicians should bear in mind that a comprehensive clinical history is useful to identify patients at risk for endometriosis, although many women remain asymptomatic. Imaging techniques can be useful to plan surgery. The effect of surgery on the fertility of women with DIE remains unanswered due to the heterogeneous nature of the disease and the lack of trials with enough statistical power and adequate followup. Surgery is not recommended when the main goal is to treat infertility or to improve IVF results. Decisions should be tailored according to the individual needs of each woman. Patients must be provided information on the potential benefits, harm, and costs of each treatment alternative, while the medical team observes factors such as presence of pelvic pain, patient age, lesion location, and previous treatments. In this scenario, management by a multidisciplinary endometriosis team is a key step to achieving successful outcomes.