Because of the inflammation and scarring associated with endometrioisis, there may be difficulty in getting pregnant. In fact, 40% of women with infertility have endometriosis. Physical examination, a patient’s history, and ultrasound or MRI may suggest endometriosis, but the only way to know for sure if there is endometriosis is to perform laparoscopic surgery. We routinely perform biopsies in this situation, and if extensive endometriosis is found, we remove all the implants and adhesions. Surgical treatment of endometriosis can help relieve or improve pain, and can restore fertility. Many times hormonal therapy, such as hormonal birth control or Lupron, is needed after surgery to further treat endometriosis and prevent or delay recurrence.