Current Concepts in the Diagnosis & Therapy of Endometriosis

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Dr. Leonhard Loimer: "You mentioned that there's mechanical endometriosis, and the shift is coming to better understand the biochemical nature and the bioactivity of endometriotic lesions as they may pertain to infertility. Clinically, when we approach patients, we have our eyes and a laparoscope. Do you see new methods coming out that will clinically help us manage our patients based on the importance of this biologic understanding?"

Professor Bruno Lunenfeld: "When I teach my students in any situation, I say - first engage your brain. Maybe get a good history, make up some kind of hypothesis, then start using your hands to confirm or to destroy your hypothesis. Once you've finished this, you start using the laboratory and visual methodology, and not the other way around like, unfortunately, some of the people are doing today by taking advantage of technology because laboratory and imaging techniques, as well as pathology, are confirmatory. It should not be used as a primary diagnosis but as a confirmatory diagnosis. If we then go further, once I have a suggestion of endometriosis, which history alone can tell me a lot about it; I then use a laparoscope. If I use a laparoscope, I will see the foci because my eye also has to see the microscopic nature of the lesion. If it is red, black, or white - it is already a lot of information but the mix forms are there. I have to have a good pathological diagnosis before I should really decide on my treatment. But again, I will make the decision when I look with the laparoscope. I need my laparoscope to look together with the biopsy to make my diagnosis, and then I start going into sophisticated situations because I'm quite sure that quite a lot of the things are done. So this is again confirmative to decide what kind of treatment I will do when. Again my treatment will be different if the woman is half a year infertile, or married, if she's one of the happiest married, if she's 35-years-old, or if she's 27-years-old. So I need all these things to consider. I really believe in what we call today "evidence based medicine" and evidence based medicine has to be number one on your brain and your intellect because - I think the nice thing and why I love to go into medicine - it is a continuous intellectual exercise. Only after I've made my intellectual diagnosis, I will go to confirmative methods first using my hands, then using the laboratory, and then using machinery like imaging."