Efficacy of laparoscopic surgery for infertile women with endometriosis

Abstract

Objective: To determine the efficacy of laparoscopic surgery for managing infertile patients with endometriosis.
Design: Retrospective study.
Setting: Assisted Reproductive technology (ART) Center, Fukuda Hospital, Kumamoto, Japan.
Patient(s): Consecutive total of 209 infertile patients who had undergone laparoscopic surgery for endometriosis as a first-line therapy were enrolled.
Intervention(s): Eighty-three women were also involved in ART programs.
Main Outcome Measure(s): Age, infertile period, revised American Fertility Society (re-AFS) score, peritubal and periovarian adhesions were compared between pregnant and nonpregnant patients. We also evaluated the pregnancy rate and infertile period, adhesion score and re-AFS score. We compared cumulative pregnancy rates in patients with no (Group CF, n = 142), unilateral (Group U, n = 41) and bilateral endometriomas (Group B, n = 26).
Result(s): An infertile period > 3 years and a mean adhesion score > 21 points were negatively correlated with pregnancy rates. There were no significant differences in pregnancy rates after surgery and after ART across the four disease stages. The cumulative pregnancy rate of Group B (53.8%) was significantly lower than Groups CF (76.1%) (p<0.01) and U (80.5%) (p<0.05).
Conclusion(s): Women with no or unilateral endometriomas and a duration of infertility > 2 years should be encouraged to undergo laparoscopic surgery. However, encouraging such women with bilateral endometriomas to move directly to ART might improve their ability to achieve a pregnancy. Further prospective studies are necessary to test this hypothesis.