This chapter illustrates the different opinions regarding the pathophysiology and management of endometriosis-associated infertility. Pelvic inflammation due to endometriosis may cause adhesion formation and scarring, which leads to a disruption and decrease in fertility. Medical treatment using GnRH agonists can only be used prior to in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). When moderate or severe endometriosis causes anatomic distortion of the pelvis in women who wish to maintain or restore fertility, surgery may be the treatment of choice. Clomiphene citrate and intrauterine insemination (IUI) treatment triple the monthly fecundity rate from 3.3 to 9.5 percent, as compared with nontreatment cycles, in patients with surgically corrected endometriosis. If laparoscopic surgery will be performed before IVF-ICSI cycles, a less invasive and conservative technique should be used during the operation such as cyst aspiration or fenestration.