The Effect of Post-Operative Suppressive Treatment in Women with Endometriosis-Related Infertility

Abstract

<h3>Study Objective</h3> To evaluate the effect of suppressive therapy on fertility and recurrence when administered after a conservative surgical treatment in women with endometriosis seeking pregnancy and to compare it with an inactive control. <h3>Design</h3> We performed a systematic review with meta-analysis. A search of MEDLINE, Embase and CENTRAL was performed by two independent reviewers from databases' inception until December 6, 2020.Two reviewers extracted data and assessed the risk of bias of the included trials (Cochrane risk-of-bias tool for randomized trials 2). Risk ratios (RR) were pooled by quantitative random effect meta-analysis. Overall strength of evidence was assessed using the GRADE method. <h3>Setting</h3> Included studies were randomized controlled trials. <h3>Patients or Participants</h3> Studies populations included reproductive-age women with endometriosis seeking pregnancy. <h3>Interventions</h3> Post-operative suppressive treatment was compared to an inactive control. <h3>Measurements and Main Results</h3> From 3138 citations, 19 trials (2028 participants) were included. No difference was observed between the treatment and the control group for pregnancy rates (RR 1.15; 95%CI 1.00, 1.32; GRADE moderate), live birth rates (RR 1.05; 95% CI 0.84, 1.32; GRADE low) and anatomical recurrence (RR 0.70; 95% CI 0.46, 1.07; GRADE low). However, when administered for three months or more, suppressive therapy significantly increased pregnancy rates (RR 1.22, 95%CI 1.04, 1.43). Post-operative suppressive therapy was also associated with reduced pain recurrence compared to control (RR 0.65; 95%CI 0.50, 0.84; GRADE moderate). <h3>Conclusion</h3> The effect of suppressive therapy administered after surgical treatment of endometriosis on fertility remains unclear but seems to increase chance of pregnancy when administered for three months or more and to effectively reduce pain recurrence after surgery.