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The American Society of Reproductive Medicine has formulated diagnostic criteria for minimal to severe endometriosis to aid in standardized description of the types and locations of implants and associated scar tissue. Pelvic pain may occur in women with minimal to severe disease; however, pain cannot be used to predict the amount or location of endometriosis implants. Severe pain may be present with minimal endometriosis and minimal or no pain may coexist with severe endometriosis. Only large implants on the ovaries that develop into endometriomas can be visualized reliably with ultrasonography. Fertility potential is impaired when endometriosis distorts the oviducts and ovaries. However, the mechanisms by which endometriosis might lead to infertility are unclear.
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