#ESHREjc report: diagnosing endometriosis loosens the Gordian knot of infertility treatment

Extract The path to the characterization of endometriosis since its first discovery by Karl von Rokitansky 150 years ago has been a rocky one (von Rokitansky, 1860). Linking histology to clinical observations was perplexed by infamous theories, such as Sigmund Freud’s attributing endometriosis symptoms to ‘hysteria’, but eventually defined a milestone that allowed progress into the development of endometriosis diagnostics. Laparoscopic surgery has been the gold standard to reliably visualize endometriosis lesions for years but non-invasive imaging methods are emerging (Leonardi et al., 2020). The recent ESHRE guidelines call for a refinement of the concept of surgery as the only diagnostic tool, calling it ‘an outdated dogma’ (Members of the Endometriosis Guideline Core Group et al., 2022). If we consider the general lack of awareness, the differences in symptomatology, the many unknown aspects of its pathophysiology, and finally the debate about diagnostic gold standard, it is not surprising that diagnosing endometriosis can take up to 7 years (Arruda et al., 2003)