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Introduction: This study has been proposed to evaluate the feasibility of trans-vaginal and trans-abdominal ultrasound in screening of endometriosis. Methods: This was a retrospective observational study in which women with clinical symptoms, features and family history of endometriosis were included. Women with diagnosed endometriosis on treatment, with chocolate cystor adenomyosis were excluded. The ultrasound features in patients with suspected endometriosis were correlated with the laparoscopy findings and a new scoring system has been introduced to facilitate the management of the disease. Results: 2080 patients were examined clinically either by per-vaginal or by per-rectal examination (in adolescents, unmarried patients) and the findings were noted and ultrasound was performed. 489 of these women had undergone laparoscopy. Combined clinical score of 1-3 is associated with USG score 1. The visualisation shows that combined clinical score of 7-9 is associated with laparoscopy score 4 and combined clinical score of 1-3 is associated with laparoscopy score 2.Combined clinical score 10-12 is highly differentiated statistically. Conclusion: Clinical symptoms, signs along with USG findings have been seen to be quite helpful to screen endometriotic cases and thereby they should be followed up closely to detect its presence. In extremely doubtful cases laparoscopy should be performed for detection of the foresaid disease. It is very important to note that the clinical score and USG score corresponds to a large extent to laparoscopy score as mentioned in the results. Keywords: endometriosis, trans-vaginal, trans-abdominal, ultrasonography, clinical, score, laparoscopy List of abbreviations USG – Ultrasonography MRI –Magnetic Resonance Imaging POD- Pouch of Douglas VAS- Visual Analogue Scale TVS- Trans-vaginal ultrasonography TRUS- Trans-rectal ultrasonography USL- utero-sacral ligament

Background: Endometriosis is an enigmatic disease that affects approximately 10% of women of reproductive age and almost 50% of women with endometriosis experience infertility. These women experience symptoms of dysmenorrhea, premenstrual pain, dyspareunia, and infertility, but many affected women are asymptomatic. Objective: To analyse the clinical pregnancy rate after treating mild and minimal endometriosis causing infertility with dienogest (2 mg) or by surgical intervention. Materials and Methods: 146 subfertile women with mild and minimal endometriosis, enrolled over a period of 36 months (January 2017 to December 2019) at Calcutta Fertility Mission have been included in the present study. They were grouped in A and B and treated with dienogest (2mg) for 90days or by laparoscopic ablation, and ovulation induction. Clinical pregnancy rates were analysed. Results: In our study, 18.52% of patients with early stage asymptomatic endometriosis, had conceived spontaneously after treatment with dienogest for 3 months, and 37.04%, 44.44% had conceived after treating them with dienogest followed by letrozole and letrozole and GnRH, for subsequent 3-6months, respectively. 13.64% , 36.36% , 50% of women had conceived spontaneously after laparoscopic ablation, after treating them with ablative procedure and letrozole and with letrozole and GnRH in the next 3-6 cycles, respectively. Spontaneous pregnancy and pregnancy following letrozole only or letrozole and GnRH in Group A and B were also not statistically significant (p - 0.961, p - 0.698). Conclusion: Clinical pregnancy in infertile women with early endometriosis treated with dienogest is non-inferior to others treated with laparoscopic ablation and minimal adhesiolysis.

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