الفهرس 
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Abstract
Laparoscopic cystectomy for ovarian endometrioma (size more than 3- 4cm: stage 3 and 4) results in improvements in pregnancy rates as compared with cyst drainage and coagulation (Godinjak et al. 2005). Endometriosis is a gynecological enigma since it is difficult to diagnose and treat. Endometriosis is a benign disease in which endometrial-like tissue persists outside of the uterus. Pelvic structures are most commonly affected, but endometriosis can involve extrauterine organs as distant as the lung (Azizad-Pinto and Clarke. 2014). True prevalence data are not known since most of studies investigate high risk groups and the fact that it is easily overlooked by the primary care physicians. However, it was estimated that it has a global prevalence of 10% among women during their reproductive years (Cramer and Missmer. 2002). Endometriosis is also reported to be associated with lower live birth rate (Mavrelos and Saridogan. 2015). Moreover, women with endometriosis tend to have other endocrine and ovulatory disorders (Teng et al. 2016). Infertility, by the WHO definition, is the failure of a sexually active couple, not using contraception to achieve a clinical pregnancy after one year or more of regular sexual intercourse (WHO. 2010). The infertility rate in the MENA[middle east and north Africa] region is around 15%, significantly higher than the 10% global average , despite old researches has suggested that the region’s infertility rate could be as high as 22.6% (Zegers-Hochschild F 2017). Male infertility is responsible for 20–30% of infertility cases, while 20– 35% are due to female infertility, and 25–40% are due to combined problems in both parts. In 10–20% of cases, no cause is found (Chowdhury and cozma 2016). Endometriosis had been associated with infertility and some studies found that infertility affects up to 50% of females with endometriosis. Some cases are diagnosed with endometriosis during the investigations of infertility (Mavrelos and Saridogan. 2015). The mechanisms by which endometriosis may cause infertility are not clearly understood, particularly when the extent of endometriosis is low. Proposed mechanisms include: • Anatomical distortions and adhesion, the release of factors from endometriotic cysts which are detrimental to gametes and affect sperm function, inflammatory markers in peritoneal fluid , epigenetic alterations of CYP19A1 gene (Da Broi and Navarro 2019). The aim of this study was to detect the incidence of endometriosis among symptomatic and asymptomatic cases of primary infertility in Tanta University Hospital over one year. Our participants divided into two groups: group (1) included cases with unexplained infertility for 1 year or more and group (2) included cases with symptoms of primary infertility and endometriosis for 1 year or more. In our study we found that among cases of un explained infertility in group (1), 28 % had endometriosis and among cases of primary infertility in group (2) , 52% had endometriosis ( P= 0.395 , chi = 0.725 ) which higher than Minko et al. (2020) who recorded that endometriosis was present among 33.7% of infertile women. In current study, the average age of women in group 1 at diagnosis was 26.88 ± 4.45 years and 25.57±5.43 years old in group 2, average duration of infertility was 2.96±1.25, 2.88±1.37 in both groups respectively. There was non significant difference between both groups regarding age, age of menarche, BMI, duration of infertility, and cycle length, this was similar to results obtaind by Minko et al. (2020). We found that there was non significant difference between both groups regarding all laboratory investigations.There was non significant difference between both groups regarding family history of endometriosis, history of previous gynecological surgery, Oral contraceptive use, and menstrual disturbances. There was high significant difference between both groups regarding pelvic pain symptoms. Most prevalent symptoms for endometriosis in this study were had chronic pelvic pain (32% in group 1, and 28% in group 2) ,dysmenorrheal (20% in both groups), dysmenorrheal together with dyspareunia (12% in group 1 and 28% in group 2). However 32% of cases in group 1 experienced no symptoms and only 0 % of group 2, our results were similar to results obtaind by Minko et al. (2020). In the present study, there was high significant difference between groups regarding TVU. As we found in group (1), 8% of cases had cysts, 8% had endometrioma and 84% show normal finding. In group (2), 28% of cases had cyst, 32% had endometrioma and 40% show normal finding . Also, there was high significant difference between groups regarding HSG, as 92% of group 1 were normal compared to 56% of group 2 had adhesions. Furthermore, there was non significant difference between groups regarding laparoscopically confirmed endometriosis, peritoneal superficial endometriosis , and ovarian endometrioma isolated. But high significant difference between them regarding endometrioma size, stages of endometriosis (rARM) classification). Additionly, there was significant difference between groups regarding DIE and total number of DIE lesions. There was high significant difference between groups regarding Dysmenorrhea of endometriosis after treatment, as 100% of group 1 had no dysmenorrhea after treatment compared to only 38.5% of group 2 had complete improvement of symptoms 90-100% after treatment. There was non significant difference between two groups regarding lesion of endometriosis and lesions of other pathology as simple cyst, hemorragic cyst, and benign tumor. In current study, there was significant difference between both groups regarding pregnancy rate. The pregnancy rate in our study was 40% in first group and 32% in second group who had endometriosis which lower than that recorded by Valson et al. (2016) as they recorded rate 36.36%.