Long term fertility outcomes after laparoscopic surgery for endometriosis-associated pelvic pain in late adolescents

Abstract

To determine long-term fertility outcomes in patients treated with laparoscopic surgery between the ages of 18 and 25 years at the Cleveland Clinic Foundation for endometriosis-associated pelvic pain. Retrospective observational case series Young women that underwent laparoscopic surgery for endometriosis-associated pelvic pain at the Cleveland Clinic Foundation between the years 2000 and 2005 were identified by electronic medical records. Exclusion criteria included documented infertility or not actively trying to conceive. Patients completed a phone questionnaire to assess measures for both spontaneous and assisted pregnancies, including whether the patient was currently pregnant, had a term or preterm pregnancy, miscarriage, ectopic pregnancy, or elective termination. Pregnancy rates were compared against an appropriate population utilizing a Chi-square test(P≤0.05). Eighty two patients met our inclusion criteria and 24 completed the phone questionnaire to assess fertility outcomes. These patients had a mean BMI and age at primary surgery of 25.3 and 22.8, respectively. Of the 24 patients that fit inclusion criteria, 21 had at least one pregnancy within the follow-up period (88%) and 19 of these patients had a spontaneous pregnancy(79%). It was determined that the probability of a spontaneous ongoing pregnancy within 1 year leading to live birth in this population was 47.3%(P=0.0013). This study showed that late adolescents who underwent laparoscopic surgery for endometriosis-related pelvic pain had increased pregnancy rates in comparison to a predicted model. Since the fertility of these patients is usually unknown at the time of initial surgery, this study indicates that surgery can be performed in these patients without a negative effect on future fertility outcomes.