Unilateral Versus Bilateral Adnexal Disease in Stage III and Stage IV Endometriosis Does Not Affect Pregnancy Outcome After Operative Laparoscopy

Abstract

Laparoscopy is the gold standard of conservative surgical treatment of infertility patients with endometriosis. Previous studies have shown improvement in fecundity rate and cumulative conception rate (CCR) after laparoscopic surgical treatment of infertile patients with early and advanced stages of endometriosis. However, none of these studies have compared the effect of unilateral versus bilateral adnexal involvement on the likelihood of achieving pregnancy after surgical treatment of advanced endometriosis. This retrospective historical cohort study evaluated the effect of unilateral versus bilateral adnexal involvement on the pregnancy rate after operative laparoscopy for infertile patients with advanced stages of endometriosis. The study subjects were 143 patients with stage III and stage IV endometriosis undergoing operative laparoscopy for infertility treatment who had primarily unilateral (n = 43, group 1) or bilateral adnexal disease (n = 100, group 2). The mean duration of infertility was 3.4 ± 2.7 years. The study was carried out at a private fertility center in Michigan. The participants were followed for up to 2 years. No significant difference was found between the unilateral and bilateral groups in pregnancy rates (28% vs. 31%), delivery rates (21% vs. 23%), miscarriage rates (25% vs. 13%), or ectopic rates (0% vs. 13%). The use of spontaneous and intrauterine insemination after surgery achieved a CCR of 59% and 49% for the unilateral group and bilateral group, respectively. These findings suggest that conservative laparoscopic surgery for advanced stages of endometriosis is an effective treatment modality to enhance the likelihood of pregnancy in infertile patients. There seems to be no difference between unilateral or bilateral adnexal involvement on the pregnancy or delivery rates and other pregnancy outcomes.