Surgery For Endometriosis Research Articles

Clinical Factors Affecting the Quality of Life of Women With Endometriosis.

The study aimed to analyse selected clinical data affecting the quality of life of women with endometriosis. A cross-sectional study. The study was conducted in 2020-2022 among 425 women with endometriosis receiving health care. A diagnostic survey method with a questionnaire technique was used. The research tools are the Endometriosis Health Profile and a standardised interview questionnaire. Infertility, medical treatment and sexual intercourse were the dimensions of quality of life most poorly rated by respondents with endometriosis. Lower quality of life was linked to the presence of painful periods, the presence of pain during intercourse and having surgery for endometriosis. The main clinical variables influencing the quality of life of women with endometriosis include problems with getting pregnant, the necessity for long-term therapy and sexual problems caused by the condition. The occurrence of painful menstruation, dyspareunia and having undergone surgery for endometriosis is associated with lower ratings of women's general quality of life. The study will help to develop a more holistic approach to caring for endometriosis patients. This will result in a better diagnosis, individualised therapy and psychological support, all of which will enhance the overall quality of life. The study's results may impact the development of health policies, endometriosis support services for women and public awareness initiatives. The study highlighted key determinants affecting health-related quality of life for women with endometriosis. The analysis of clinical data revealed that infertility, treatment and dyspareunia are the dimensions of quality of life most poorly rated by women with endometriosis. These findings are significant for those providing care to women with endometriosis, as well as for policymakers responsible for the organisation of health care systems. The STROBE guidelines. No patient or public contribution.

Spontaneous hemoperitoneum in a 29-week pregnancy with a history of endometriosis: A case report and review of the literature.

Spontaneous hemoperitoneum in pregnancy (SHIP) is defined as sudden, nontraumatic intraperitoneal bleeding that occurs during pregnancy or up to 42 days postpartum. The incidence ranges between 4 and 4.9 per 100 000 births. Although seen rarely, it is associated with perinatal morbidity and mortality due to maternal hemodynamic instability. Endometriosis was shown to be present in 71% of SHIP cases. A 30-year-old primigravid woman with a spontaneous conception, at 29 weeks of gestation, presented to our obstetrics and gynecology emergency department with complaints of abdominal and back pain. In terms of her medical history, a laparoscopic cystectomy was performed in August 2022 due to a 90 mm × 50 mm endometrioma in the right ovary. However, deep endometriosis and adenomyosis were not observed. After decelerations appeared on the non-stress test, the repeat hemoglobin values dropped to 7.2 g/dL, with blood pressure at 70/50 mm Hg and a pulse rate of 95/min. The decision was made for laparotomy and emergency delivery of the baby. It is crucial to consider SHIP, especially in pregnant patients with a history of endometriosis surgery. Managing such high-risk cases in specialized centers and easily identifying predisposing factors for SHIP can lead to improved outcomes, despite its rarity and poor prognosis.

Experience of using robot-assisted (da Vinci) operations in the treatment of common endometriosis

Background. Currently, genital endometriosis is considered as one of the most severe conditions in women of reproductive age, which has detrimental consequences for social, professional and psychological functioning. It ranks third in the structure of gynecological diseases after inflammatory diseases of the female reproductive system and uterine fibroids. Because of this, it acquires a more pronounced social significance and ceases to be only a medical problem. Aim. To study the results of surgical treatment of patients with severe forms of genital endometriosis using the da Vinci surgical robotic complex.Materials and methods. A retrospective analysis of the treatment results of 51 patients operated on at the N.I. Pirogov National Medical and Surgical Center for the period from January 2015 to July 2024, who underwent robot-assisted (da Vinci) operations for deep endometriosis involving neighboring organs. The duration of surgery and hospital stay, the amount of blood loss, the frequency of intra- and postoperative complications, the clinical course of the disease in the long-term postoperative period, the frequency of detection of residual infiltration in the postoperative period, and the implementation of reproductive plans were analyzed.Results. The duration of the surgical intervention was 220.8 ± 21.87 minutes. The postoperative bed-day was 6.9 ± 1.5 bed days. The average blood loss was 160.2 ± 67.58 ml. There were no intraoperative complications. Postoperative complications accounted for 7.8 %. Residual infiltration occurred in 11.7 % of cases. 94.1 % of the patients had no clinical symptoms of endometriosis in the long-term postoperative period. The pregnancy rate was 31.9 %.Conclusion. Surgical treatment of deep endometriosis using da Vinci surgical robotic complex in the amount of radical removal of endometrioid infiltrate has a positive effect on both the clinical course of the disease and the reproductive potential of a woman. Real-time fluorescence navigation has demonstrated additional imaging capabilities in robotic surgery for deep endometriosis, potentially increasing the radicalism of surgical treatment of infiltrating endometriosis and may lead to a reduction in recurrence rates.

Adenomyosis Localized in Both the Anterior and Posterior Myometrium Is Associated with Deep Rectal Endometriosis: A Retrospective Study

Background: Endometriosis and adenomyosis are two closely related, estrogen-dependent, benign gynecological diseases. The available evidence on their common pathogenesis and association is limited and often does not address the heterogeneity of both entities. The aim of our study is to investigate the association between different types and localizations of adenomyosis and endometriosis phenotypes, using magnetic resonance imaging (MRI) and laparoscopic findings. Methods: We performed a retrospective observational study involving premenopausal women over 18 years old who underwent laparoscopic surgery for endometriosis and were pre-operatively diagnosed with adenomyosis through MRI examination at the Cantonal Hospital of Schaffhausen, Switzerland between 2011 and 2022. Results: Of 130 patients with adenomyosis, 23 (17.7%) women had adenomyosis only in the anterior wall (group 1), 38 (29.2%) only in the posterior wall (group 2), and 69 (53.1%) in both the anterior and posterior wall (group 3). Women in group 1 experienced significantly more dysuria compared to the two other groups (p = 0.018), while the prevalence of other pain symptoms (dysmenorrhea, dyspareunia, dyschesia) was comparable between the groups. Women in group 3 had significantly thicker anterior and posterior myometrium compared to groups 1 and 2 (p < 0.001). Co-existence of deep rectal endometriosis was more frequent in women from group 3 compared to groups 1 and 2 (p = 0.039) and in women with adenomyosis in the outer (extrinsic) compared to adenomyosis in the inner myometrium (intrinsic) (p < 0.001). Conclusions: This study provides evidence of an association between the localization of adenomyosis and the distribution of concomitant endometriosis. Specifically, adenomyosis localized in both the anterior and posterior wall appears to be more proliferative compared to adenomyosis found only in the anterior or posterior wall. This is indicated by its association with higher uterine volume, thicker posterior junctional zone, and greater myometrial thickness and with a higher co-existence with deep rectal endometriosis. These findings support an association between the development of specific subtypes of both entities, which represents a valuable resource for the identification of future targets for the treatment and clinical management of adenomyosis and endometriosis.

12364 Evaluation of the Quality of Life Before and After Endometriosis Surgery in Patients from the Public or Private Sector in Brazil

12364 Evaluation of the Quality of Life Before and After Endometriosis Surgery in Patients from the Public or Private Sector in Brazil

Endoscopic closure of rectosigmoid injury with OTS clip after laparoscopic surgery for extensive endometriosis

Endoscopic closure of rectosigmoid injury with OTS clip after laparoscopic surgery for extensive endometriosis

12366 Surgical Outcomes of the National Training Program (PROADI) for Minimally Invasive Surgery for Endometriosis in Brazil

12366 Surgical Outcomes of the National Training Program (PROADI) for Minimally Invasive Surgery for Endometriosis in Brazil

Developing a Systematic Evidence-Based Approach to Endometriosis Surgery

Developing a Systematic Evidence-Based Approach to Endometriosis Surgery

Revolutionizing endometriosis treatment: automated surgical operation through artificial intelligence and robotic vision.

Clinical limitations due to poverty significantly impact the lives and health of many individuals globally. Nevertheless, this challenge can be addressed with modern technologies, particularly through robotics and artificial intelligence. This study aims to address these challenges using advanced technologies in robotic surgery and artificial intelligence, proposing a method to fully automate endometriosis robotic surgery with a focus on interpretability, accuracy, and reliability. A methodology for fully automatic endometriosis surgery is introduced. Given the complexity of endometriosis lesions detection, they are categorized by their anatomical location to improve system interpretability. Then, three ensemble U-Net frameworks are designed to detect and localize common types of endometriosis lesions intraoperatively. A cross-training approach is employed, exploring U-Net models with diverse neural architectures-such as ResNet50, ResNet101, VGG19, InceptionV3, MobileNet, and EfficientNetB7-to develop U-Net ensemble models for precise endometriosis lesions segmentation. A novel image augmentation technique is also introduced, enhancing the segmentation models' accuracy and reliability. Furthermore, two U-Net models are developed to localize the ovaries and uterus, mitigating unexpected noise and bolstering the method's accuracy and reliability. The image segmentation models, assessed using the Intersection over Union (IoU) metric, achieved outstanding results: 97.57% for ovarian, 96.35% for uterine, and 92.58% for peritoneal endometriosis. This study proposes a fully automatic method for some common types of endometriosis surgery, including ovarian endometriomas and superficial endometriosis. This method is centered around three ensemble U-Net frameworks and a noise reduction technique using two additional U-Nets for localizing the ovaries and uterus. This approach has the potential to significantly improve the accuracy and reliability of robotic surgeries, potentially reducing healthcare costs and improving outcomes for patients worldwide.

Self-Cross-Linked Hyaluronic Acid Gel for Adhesion Prophylaxis in Laparoscopic Deep Endometriosis Removal: Safety Report of a Prospective Pilot Study

Background/Objectives: Surgical removal of deep endometriosis lesions is an established method of reducing patient symptoms, but it often results in iatrogenic adhesions that lead to further problems. This pilot study presents the safety evaluation of a novel self-cross-linked hyaluronic acid gel used to reduce adhesions after non-bowel deep endometriosis surgery. Methods: A single cohort, single-center, non-randomized pilot study was conducted in patients diagnosed with non-bowel deep endometriosis who underwent a three-stage treatment regimen consisting of first surgery, hormone therapy and second surgery. The present report is limited to an analysis of the inflammatory parameters, pain and complications occurring within a 72 h period following the initial laparoscopy (FLL) utilizing the anti-adhesion gel. Results: 60 patients (28.48 ± 5.9 years old) were included. 24 h after the intervention, a slight elevation in C-reactive protein levels was observed in 38.33% of cases (0.98 ± 1.46 mg/dL), with a statistically significant difference after FLL (0.98 ± 1.46 mg/dL before FLL vs. 1.03 ± 1.29 mg/dL after FLL; p =< 0.001); there were no patients with levels above 10 mg/dL before or after surgery. 24 h after FLL, 29.33% of patients had a leukocyte count greater than 11 Thous/μL, with a maximum observed value of 16.2 Thous/μL. The count was found to be statistically significantly higher after FLL (6.03 ± 1.91 Thous/μL before FLL vs. 9.15 ± 2.61 Thous/μL after FLL; p =< 0.001). At 72 h post-intervention, postoperative pain was reported in up to 63.33% of cases, and one urinary tract infection with fever occurred but was not considered to be related to the product. No serious adverse events were observed. Conclusions: The results of this exploratory study showed a safe range of inflammatory response within a 24 h period following the application of the novel self-cross-linked hyaluronic acid antiadhesion gel (HyaRegen®) in patients who underwent laparoscopic surgery for non-bowel deep endometriosis.

Pentraxin-3 is a novel marker for the diagnosis of endometriosis

Introduction: Endometriosis is one of the most common reproductive disorders affecting women. The pathophysiology of endometriosis is also quite complicated, and many mechanisms have been put forward. Pentraxin-3 is a glycoprotein released by leukocyte and myeloid dendritic cells in peripheral blood with the stimulation of some cytokines, especially IL-1 and TNF-α, Toll-Like Receptor agonists, or microbial components. It has been shown that pentraxin-3 is also released from ectopic endometrial cells. The aim of this study is to investigate serum pentraxin-3 levels and their correlation with endometriosis in women with endometriosis and healthy women without endometriosis. Methods: This case-control study evaluated patients diagnosed with endometriosis based on imaging techniques or laparoscopy between 2018 and 2020. Serum samples of 71 patients who had been diagnosed with endometriosis as a case group and 56 healthy patients who had undergone laparoscopic tubal ligation and were proven to be endometriosis-free as a control group were compared for pentraxin-3 level. Results: Serum pentraxin-3 level was significantly higher in the endometriosis group compared with the control group ( p < 0.05). Parity and gravida were significantly higher in the control group than in the endometriosis group. When patients with endometriosis surgery history were excluded, there was no significant change in serum pentraxin-3 levels in patients with medical treatment for endometriosis ( p > 0.05). Both the sensitivity and specificity of serum pentraxin-3 were 73.2%. Conclusions: These results demonstrate a relationship between serum pentraxin-3 and endometriosis. Serum pentraxin-3 might be used as a non-invasive method for the diagnosis of endometriosis.

Pregnancy and Neonatal Outcomes in Women Treated for Bowel Endometriosis: A Seven-Year Single-Centre Retrospective Matched Cohort Study

Background/Objectives: Deep infiltrating endometriosis has been linked to worsened maternal and neonatal outcomes. However, reports regarding bowel endometriosis are still scanty. We aimed to evaluate pregnancy, delivery, and newborn adverse outcomes in women after laparoscopic-assisted surgery for bowel endometriosis. Methods: A single-center retrospective cohort study was conducted at a tertiary-care university hospital. From January 2015 to December 2021, pregnant women who were diagnosed and treated for bowel endometriosis were matched using a 1:3 ratio with pregnant women with no history of endometriosis. Patients were matched using the Cox proportional hazards model to determine parity, age, BMI and gestational age-adjusted relative risk (aRR) with a 95% confidence interval (CI). Co-primary outcomes were the incidence of labor abnormalities and cesarean section (CS) rate. Co-secondary outcomes were incidence of complications related to pregnancy, delivery, and newborn. Results: A total of 71 pregnancies among women treated for bowel endometriosis and 213 from healthy controls were included. Patients requiring IVF/ET for getting pregnant were in the bowel endometriosis group relative to controls (43.7% vs. 11.7%; p < 0.001). Increased risk of labor abnormalities was present for bowel endometriosis relative to controls (21.1% vs. 17.4%; p = 0.040; aRR 1.39 [95% CI 1.06–2.05]). Risk of non-cephalic fetal presentation (14.1% vs. 6.1%; p = 0.016; aRR 3.08 [95% CI 2.03–4.68]), CS rate (43.7% vs. 24.9%; p = 0.003; aRR 1.75 [95% CI 1.23–2.49]), and emergent CS rate (19.7% vs. 8.5%; p = 0.009; aRR 2.21 [95% CI 1.55–3.16]) were significantly higher in women treated for colorectal endometriosis compared with controls. Moreover, placenta previa (9.9% vs. 0.0%; p < 0.001; aRR 21.82 [95% CI 2.19–116.40]), second-trimester hemorrhage (5.6% vs. 0.9%; p = 0.017; aRR 6.00 [95% CI 1.12–32.06]), postpartum hemorrhage (15.5% vs. 3.3%; p < 0.001; aRR 4.71 [95% CI 1.90–11.70]), and the need for transfusion during labor (5.6% vs. 0.5%; p = 0.004; aRR 12.00 [95% CI 1.36–105.60]) were increased in treatments vs. controls. Concerning neonatal outcomes, an increased risk for neonatal intensive care unit admission was seen in postsurgical endometriotic women relative to healthy controls (26.0% vs. 6.9%; p < 0.001; aRR 3.75 [2.04–3.86]). Conclusions: Women treated for bowel endometriosis seem more exposed to adverse pregnancy and neonatal outcomes relative to healthy controls. However, additional prospective and comparative studies are needed to validate the available evidence.

Surgical Antifragility Lessons Learned from Endometriosis Surgery

Surgical Antifragility Lessons Learned from Endometriosis Surgery

Robot-Assisted Nerve-Sparing Eradication of Deep Endometriosis Using the da Vinci SP

ObjectiveThe evolution of nerve-sparing surgery has been supported by a growing body of literature on anatomic details, dissection techniques, and functional outcomes, suggesting that nerve-sparing surgery for deep endometriosis (DE) reduces postoperative pelvic organ dysfunction, including voiding and rectal dysfunction [1]. Recently, newer single-port robotic systems (da Vinci SP) have become available with articulating instruments and cameras that allow for intracorporeal triangulation, which may overcome some of the weaknesses of conventional single-port laparoscopic surgery [2]. Although such systems are believed to allow more complex surgeries than conventional single-port laparoscopic surgery, the scope of application remains unexplored. The objective of this video is therefore to demonstrate the anatomical and technical highlights of a complex intrapelvic procedure, nerve-sparing modified radical hysterectomy and complete removal of DE using the da Vinci SP (SP). SettingAn urban general hospital. Stepwise demonstration of the technique with narrated video footage. ParticipantsThe patient was a 47-year-old woman who presented with chronic pelvic pain resistant to pharmacotherapy. Magnetic resonance imaging showed uterine adenomyosis and bilateral ovarian endometrioma with DE, involving the uterosacral ligament and surface of the rectum, with complete cul-de-sac obliteration. InterventionsThe surgical steps were completely identical to conventional multiport laparoscopic robotic surgery [3,4]. This suggests that conventional laparoscopic or robotic skills are highly transferrable to SP. SP offer several advantages, including high-resolution three-dimensional visualization, articulating instruments, and improved dexterity and range of motion. These advantages allow us to comfortably perform meticulous dissection and suturing even in difficult situations such as DE. The postoperative course was uneventful, with no perioperative complications, including no postoperative bladder or rectal dysfunction [5]. She was very satisfied with the invisible operative scar and low degree of postoperative pain. ConclusionNerve-sparing eradication of DE using SP is technically safe and feasible, with cosmetic advantages and less pain.

Progesterone receptor status predicts aggressiveness of human endometriotic lesions in murine avatars

To utilize murine avatars for studying human endometriotic lesion response to two different hormonal regimens to determine if PR can prospectively predict response to progestin-based therapy. Endometriosis is a chronic gynecologic disease afflicting 1-in-10 reproductive-aged women; however response to medical therapy is highly variable as endometriotic lesions do not consistently respond to first-line, progestin-based therapy. We have previously demonstrated in a retrospective study that progesterone receptor (PR) status in lesions correlated with response to progestins. Here, we hypothesize that a prospective approach utilizing PR status to predict response to medical will allow clinicians to individualize effective, timely treatment for this debilitating disease. Patient-Derived Xenograft Murine Model SUBJECTS: Eight-week old NOD/SCID mice undergoing transplantation of endometrioma lesions collected from women undergoing surgery for endometriosis. Daily subcutaneous injections with vehicle (DMSO), Medroxyprogesterone acetate (MPA) or GnRH antagonist, Cetrorelix for 1 month. Lesion size 1 month post-treatment RESULTS: Lesions with high PR demonstrated a robust response to MPA compared to lesions with low PR. Average post-MPA treatment size in high PR lesions was 6-fold smaller than low PR lesions. Low PR lesions respond far more completely to GnRH antagonist than to MPA. Surprisingly, there were differences in response to GnRH antagonist between low and high PR lesions. High PR lesions responded almost completely to GnRH antagonist with a 21-fold smaller post-treatment size on average compared to low PR lesions. Use of murine avatars to test clinical response is a novel approach in endometriosis. Hormonal suppression of disease is a cornerstone of therapy, however response is not fully predictable. We have previously shown that women with low PR lesions respond poorly to progestin-based therapy. Here, we prospectively validate our prior work using a mouse xenograft model, demonstrating that lesions with low PR expression do not respond to progestin-based therapy; PR status predicted response to progestin-based therapy. Moreover, PR status identifies a more aggressive form of endometriosis that is not only progesterone resistant, however is also less dependent on estradiol for growth. Our findings highlight the need to develop novel, nonhormonal therapies aimed at targeting the more aggressive forms of endometriosis that do not rely on the usual hormonal signals.

Surgical Enhancement with the Placement of Temporary Bilateral Ureteral Stents with Indocyanine Green Injection for all Stages of Endometriosis in vNOTES: Retrospective Cross-Sectional Study

Study ObjectiveTo demonstrate the time to place temporary bilateral stents with indocyanine green (ICG) injection, time to intra-operative identification of bilateral ureters - with and without the use of ICG, and number of times for ICG activation in endometriosis excision surgery. DesignRetrospective cross-sectional study. SettingSingle Tertiary Academic Hospital. PatientsFifty serial patients with functioning pelvic ureters, who underwent vaginal natural orifice transluminal endoscopic surgery (vNOTES) for all stages of endometriosis excision between September 2023 and May 2024. InterventionsPlacement of temporary bilateral ureteral stents with indocyanine green injection before the start of vNOTES, noting the time needed to identify intra-peritoneal ureters with and without ICG activation, and average number of times ICG was activated for endometriosis excision. Measurements and Main ResultsThe median time to place bilateral ureteral stents with ICG injection was 229 seconds. The median time for intra-operative ureteral identification with ICG was 1s (L) and 1s (R). The median time for intra-operative ureteral identification without ICG was 17s (L) and 17s (R). The median time ICG was activated for ureteral identification to perform endometriosis excision was 12 times (L), 11 times (R). From the observations previously described, we share the potential of improved efficiency and efficacy in using ICG in ureteral identification for endometriosis surgery. ConclusionPlacement of temporary bilateral ureteral stents with ICG has the potential for more efficient ureteral identification even after including time for ureteral stent placement and ICG injection. The upfront time needed to place stents may prove to lead to a safer, more efficient procedure.

A New Vision in Endometriosis Surgery: The Impact of Near-Infrared Indocyanine Green Fluorescence Imaging

A New Vision in Endometriosis Surgery: The Impact of Near-Infrared Indocyanine Green Fluorescence Imaging

Surgical techniques for ovarian endometriosis

Key content: All patients with ovarian endometriosis should be offered an individualised, shared decision‐making approach informed by clinical history, symptoms and fertility status. Surgical management of ovarian endometriosis can be effective in treating endometriosis‐associated pelvic pain and infertility, but there is no current evidence that surgery for ovarian endometriosis increases the success of in vitro fertilisation (IVF) treatment. Ovarian reserve tests should be considered before any ovarian surgery and can help guide the patient towards the optimal treatment. The Endometriosis Fertility Index should be incorporated into pre‐operative consultations as a validated tool that estimates the likelihood of spontaneous conception following surgical intervention. Surgeons should be trained in different surgical techniques, types of diathermy and haemostatic agents that can minimise the risk of inadvertent injury to normal ovarian cortex. Learning objectives: To facilitate informed decision‐making regarding the treatment of ovarian endometriosis. To gain insight into the possible surgical techniques available to manage ovarian endometriosis and the evidence behind them. To understand the impact of each technique on endometriosis‐associated pain, fertility outcomes and recurrence rates. Ethical considerations: Should fertility preservation be offered to all women of reproductive age with fertility aspirations and a diagnosis of endometriomas? Should integrated care boards (ICBs) devise specific criteria to offer funding for fertility preservation as an option before surgery for ovarian endometriosis?

Is Complete Excision Always Enough? A Quality of Sexual Life Assessment in Patients with Deep Endometriosis.

Background and Objectives: The aim of this study was to find the factors associated with the severe impairment of QoSL and the factors associated with a better score in QoSL, as well as the evaluation of pain symptoms and QoSL after the complete and incomplete excision of rectovaginal nodules. Materials and methods: The present prospective study was conducted in a single tertiary center for endometriosis where 116 patients underwent laparoscopic surgery for deep endometriosis during a 3-year period. The goal of the intervention was to excise all endometriotic implants while conserving the rectum. Intraoperative findings were recorded after the intervention, and the patients were classified according to the ENZIAN classification and rASRM scores. QoSL was assessed using the EHP-30 Module C (QoSL Score). Results: When comparing the mean scores before and 2 years after the surgery, a highly significant improvement was found for QoSL and dysmenorrhea (p < 0.0001). The complete excision of rectovaginal nodules led to a significantly better QoSL and lower dyspareunia (p < 0.0001) than incomplete resection (p < 0.02). Conclusions: This prospective study proves that the complete laparoscopic excision of all endometriotic implants improved the QoSL and decreased the pain score of dyspareunia. Incomplete rectovaginal nodule excision was correlated with a poorer QoSL and a lower improvement of dysmenorrhea, dyspareunia, and chronic pelvic pain scores than complete excision.

Effects of pretreatment with long-acting gonadotropin-releasing hormone agonists on pregnancy outcomes in patients with minimal and mild peritoneal endometriosis: A retrospective study of 274 frozen-thawed embryo transfer cycles.

To investigate the effects of pretreatment with long-acting gonadotropin-releasing hormone agonist (GnRH-a) before frozen-thawed embryo transfer (FET) on pregnancy outcomes in patients after minimal-mild (stages I-II) peritoneal endometriosis surgery. A retrospective cohort study was performed from March 2018 to May 2019. Overall, 274 patients met inclusion criteria of undergoing FET after minimal/mild peritoneal endometriosis surgery. For the FET protocol, patients were divided into 2 groups: GnRH-a plus hormone replacement therapy (HRT) (group A, n = 154) and HRT-only (group B, n = 120), with the former divided into 2 subgroups receiving 1 (group A1, n = 80) or 2 doses (group A2, n = 74) of GnRH-a. Basic characteristics and pregnancy outcomes of groups A and B and groups A1 and A2 were compared. Clinical pregnancy rate (CPR) and live birth rate (LBR) were the primary outcomes and logistic regression was used to analyze independent correlation factors. The CPR and LBR in group A were 58.4% and 50.0%, respectively, and were not significantly higher than in group B (49.2% and 40.0%; respectively, χ2 = 2.339, P = .126 and χ2 = 2.719, P = .099, respectively). CPR and LBR in group A1 were not significantly lower than those in group A2 (52.5% and 45.0% vs 64.9% and 55.4%, respectively; χ2 = 2.420, P = .120 and χ2 = 1.665, P = .197, respectively). However, group A2's CPR and LBR were significantly higher than group B's (64.9% and 55.4% vs 49.2% and 40.0%, respectively; χ2 = 4.560, P = .023 and χ2 = 4.375, P = .026, respectively). Logistic regression analysis showed that GnRH-a pretreatment (1 or 2 doses) had no significant effect on CPR and LBR compared with the HRT-only group. Patients with minimal-mild (stages I-II) peritoneal endometriosis surgery may not require GnRH-a pretreatment before FET.