Abstract
Purpose: Researching reproductive outcome after laparoscopic radical resection of grade III and IV endometrial lesions. Methods and Materials: A retrospective analysis of 54 women was carried out. The patients underwent laparoscopic radical resection in the Gynecology Department of a secondary health care center between January 2009 and December 2013. Diagnostic investigation, with histological confirmation of moderate to severe endometriosis, preceded surgical intervention in a multidisciplinary setting. Thirty seven of the 54 patients had an active desire for pregnancy. The outcome measure was the number of pregnancies in the subgroup of 37 women with an active desire for pregnancy. Results: Within the subgroup of 37 patients, 28 women became pregnant within the study period. Twelve patients became pregnant spontaneously and 16 had medically assisted pregnancies. Within the medically assisted group, 4 patients conceived after Intra-Uterine Insemination (IUI) and 12 after In- Vitro Fertilization (IVF). The pregnancy rate was 76%, a result similar to findings of earlier studies. Conclusion: The results of this retrospective analysis suggest that extensive laparoscopic surgery for moderate to severe endometriosis has a beneficial effect on fertility in both spontaneous and medically assisted pregnancies.
Highlights
Endometriosis is a prevalent condition defined by endometrial tissue outside the uterine cavity
Discussion remains over whether the surgical approach is beneficial in relation to fertility in cases with grade III to IV endometrial lesions
A pregnancy rate of 76% confirms earlier results presented by Adamson G et al (44% pregnancy rate after laparoscopy and 62% after laparotomy)
Summary
Endometriosis is a prevalent condition defined by endometrial tissue outside the uterine cavity. Some observational studies describing an elevated chance of pregnancy using GnRH without surgical approach exist, the 2014 Cochrane review of these studies showed little evidence. Benefit of this approach remains controversial [12]. Discussion remains over whether the surgical approach is beneficial in relation to fertility in cases with grade III to IV endometrial lesions. A recent prospective cohort study by Vercellini P. et al [17] showed that, in the case of rectovaginal endometriosis, the surgical approach did not increase fertility in comparison to the control group with the conservative approach. The question remains whether the surgical approach to grade III and IV lesions improves the chance of pregnancy in patients with endometriosis. This question is central to our study, where the surgical approach for endometriosis is performed in a multidisciplinary setting
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