Pregnancy Rates After Surgical Treatment of Deep Infiltrating Endometriosis in Infertile Patients With at Least 2 Previous In Vitro Fertilization or Intracytoplasmic Sperm Injection Failures

Breteau, Pauline; Chanavaz-Lacheray, Isabella; Rubod, Chrystèle; Turck, M.; Sanguin, Sophie; Pop, Ionut; Roman, Horace

doi:10.1016/j.jmig.2019.08.032

Cited by 18 publications

(6 citation statements)

References 23 publications

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“…Soriano et al [ 19 ] suggested that extensive laparoscopic surgery could improve IVF outcomes for patients with severe endometriosis and repeated in vitro fertilization failures. Similarly, Breteau et al [ 20 ] discovered that infertile women with ≥ 2 IVF–ICSI failures should be referred for surgery and that the mean time from surgery to pregnancy is 11.1 months, which is similar to the median time to pregnancy of 12 months following attempts to conceive for all pregnancies. Therefore, surgery for DIE does not routinely delay conception.…”

Section: Discussionmentioning

confidence: 94%

“…Therefore, surgery is required for DIE patients with obvious pain symptoms or clinically relevant intestinal or ureteral stenosis. Surgery might also be considered in young women who have repeated IVF failures [ 20 ]. Recent studies have also considered whether new technologies could improve surgical treatments for endometriosis; several have already found that the use of diode laser, plasma or CO2 lasers could improve pain symptoms and quality of life in selected cases [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

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Reproductive and postsurgical outcomes of infertile women with deep infiltrating endometriosis

et al. 2022

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Background This study aimed to summarize and analyze clinical characteristics and reproductive outcomes in postoperative deep infiltrating endometriosis (DIE). Methods This retrospective cohort study included 55 reproductive-aged patients who were diagnosed with DIE, wished to conceive and underwent resection surgery at the Obstetrics and Gynecology Hospital, Fudan University, from January 2009–June 2017. Those with any plausible infertility factor or abnormalities in the partner’s semen analysis were excluded. Patient characteristics, preoperative symptoms, infertility history, intraoperative findings and reproductive outcomes were followed up and recorded. Risk factors for reproductive outcomes were identified for women who became pregnant versus those who did not by univariate logistic regression. Additionally, pre- and postoperative endometriosis health profile questionnaire-30 (EHP-30), Knowles–Eccersley–Scott Symptom questionnaire (KESS), Cox Menstrual Symptom Scale (CMSS) and Female Sexual Function Index (FSFI) scores were used to evaluate the effect of DIE surgery on quality of life. Results The average age was 30.22 ± 3.62 years, with no difference between the pregnancy and nonpregnancy groups. The average follow-up time was 26.57 ± 14.51 months. There were 34 pregnancies (61.82%): 24 (70.59%) conceived spontaneously and 10 (29.41%) by in vitro fertilization (IVF). Twenty-eight patients (82.35%) had term deliveries. The interval between operation and pregnancy was 10.33 ± 5.6 (1–26) months. Univariate analysis showed that a lower endometriosis fertility index (EFI) score (EFI < 8) was a risk factor for infertility (OR: 3.17 (1.15–10.14), p = .044). For patients with incomplete surgery, postoperative gonadotropin-releasing hormone agonist (GnRHa) administration improved the pregnancy rate (p < 0.05). Regarding quality of life, there was significant improvement (p < 0.05) in the postoperative EHP-30, KESS and CMSS scores compared with preoperative scores in both groups. Although there was no obvious difference in FSFI scores, significant improvement in dyspareunia was observed (p < 0.05). Conclusions Overall, the postoperative pregnancy rate of DIE patients was 61.82%. Surgical management of DIE for patients with complaints of pain and with pregnancy intentions was feasible and effective. Long-term expectant treatment should not be advised for patients with lower EFI scores (EFI < 8), and postoperative IVF–ET may be a good choice. More cases should be enrolled for further study, and randomized studies are required.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Reproductive and postsurgical outcomes of infertile women with deep infiltrating endometriosis

et al. 2022

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“…In women with severe endometriosis who have experienced failed IVF cycles there is evidence that as many as 42.3% will achieve a pregnancy through IVF after surgical excision of disease. 99,100 Expert advice is to offer surgical excision of DE for pain symptoms and patient preference. In symptomatic women with a history of failed IVF then disease excision could be considered.…”

Section: Surgical Treatment Of Endometriosis Prior To Artmentioning

confidence: 99%

Endometriosis and subfertility

Morris,

Lilly,

Jefferys

et al. 2024

The Obstetric & Gynaecologis

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Key content Medical management of endometriosis is often contraceptive. In contrast, surgical treatment may improve the chance of spontaneous conception. There is conflicting evidence as to whether surgery improves outcomes with assisted conception, and this should be discussed with a specialist in reproductive medicine. Surgery, particularly for ovarian endometriosis, can cause a decreased ovarian reserve and fertility preservation should be considered. There is no standard approach to managing endometriosis in the fertility setting. It is important to take a holistic approach to diagnosis and management of the subfertile couple where endometriosis may be a contributing factor. Learning objectives To understand the mechanisms by which endometriosis can contribute to subfertility. To understand the importance of a comprehensive assessment of the subfertile couple and the important factors that will inform an individualised management plan. To develop a framework for managing endometriosis in the context of subfertility including fertility preservation

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“…In this review, the pregnancy rate and the live birth rate were respectively 1.84 and 2.22 times more likely for patients with previous surgery than those receiving IVF without previous surgery. Moreover, DE surgery appears to be a valid option for infertile women with ≥2 IVF failures in order to improve spontaneous fertility and also IVF results [ 94 ].…”

Section: Shaving Technique: Surgical Proceduresmentioning

confidence: 99%

Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases

Donnez¹

2021

JCM

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Deep endometriosis infiltrating the rectum remains a challenging situation to manage, and it is even more important when ureters and pelvic nerves are also infiltrated. Removal of deep rectovaginal endometriosis is mandatory in case of symptoms strongly impairing quality of life, alteration of digestive, urinary, sexual and reproductive functions, or in case of growing. Extensive preoperative imaging is required to choose the right technique between laparoscopic shaving, disc excision, or rectal resection. When performed by skilled surgeons and well-trained teams, a very high majority of cases of deep endometriosis nodule (>95%) is feasible by the shaving technique, and this is associated with lower complication rates regarding rectal resection. In most cases, removing a part of the rectum is questionable according to the risk of complications, and the rectum should be preserved as far as possible. Shaving and rectal resection are comparable in terms of recurrence rates. As shaving is manageable whatever the size of the lesions, surgeons should consider rectal shaving as first-line surgery to remove rectal deep endometriosis. Rectal stenosis of more than 80% of the lumen, multiple bowel deep endometriosis nodules, and stenotic sigmoid colon lesions should be considered as indication for rectal resection, but this represents a minority of cases.

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Pregnancy Rates After Surgical Treatment of Deep Infiltrating Endometriosis in Infertile Patients With at Least 2 Previous In Vitro Fertilization or Intracytoplasmic Sperm Injection Failures

Cited by 18 publications

References 23 publications

Reproductive and postsurgical outcomes of infertile women with deep infiltrating endometriosis

Reproductive and postsurgical outcomes of infertile women with deep infiltrating endometriosis

Endometriosis and subfertility

Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases

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