{"paper_id":"f084a119-0693-4baa-88e2-9f2cf3d7ad90","body_text":"Abstract\nIntroduction\nOvarian endometriosis is the most common type of endometriosis (EM), affecting more than 40% of women with EM. Currently, surgical intervention is still controversial in infertile patients with ovarian endometriosis, especially in those with stage III–IV EM. Very few studies have been done to analyze long-term pregnancy results in patients with endometrioma more than 5 years after surgery. Therefore, the aim of this study was to explore the pregnancy outcomes and the related factors in patients with endometrioma and stage III–IV endometriosis during a long-term follow-up postoperatively.\nMethods\nWe collected 347 patients with ovarian endometriosis, which included 59 infertile patients with stage III–IV endometriosis who had a minimum of 5 years of postoperative follow-up after undergoing laparoscopic excision of ovarian endometriomas performed by a single doctor at the Peking Union Medical College Hospital from January 2009 to April 2013.\nResults\nA total of 59 infertile patients were recruited. The mean age was 31.8 ± 3.6 years. The mean size of the endometriomas was 6.8 ± 3.3 cm. Before surgery, dysmenorrhea was present in 88.1% (52/59) of the cases, while chronic pelvic pain was reported in nine cases (15.3%). A total of 20.3% (12/59) of cases were concurrent with leiomyoma, 52.5% (31/59) with deep infiltrating endometriosis (DIE), and 39.0% (23/59) with adenomyosis. During laparoscopy, 21 cases were diagnosed as stage III (35.6%) and 38 as stage IV (64.4%) EM according to the revised American Fertility Society (AFS) classification. After laparoscopic cystectomy, 38 (64.4%) patients became successfully pregnant by the 5th year. All the patients were divided into two groups according to the postoperative pregnancy outcomes. In univariate analysis, the higher mean age and concurrent diagnosis of adenomyosis were seen to be related to poor postoperative pregnancy outcomes (p < 0.05). In multivariate analysis, however, the mean age, chronic pelvic pain (CPP), and adenomyosis were independent risk factors of pregnancy outcomes between the two groups (p < 0.05). With a minimum follow-up of 6 years, 23.7% (14/59) of recurrence was observed in the entire study cohort.\nConclusion\nInfertile patients with endometrioma and stage III–IV EM may have lower pregnancy rates after laparoscopic cystectomy if they are older and present with CPP and adenomyosis. Our data showed a lower rate of recurrence but a higher rate of pregnancy after surgery.\nSimilar content being viewed by others\nReferences\nGiudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789–99.\nGiudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010;362(25):2389–98.\nMeuleman C, Vandenabeele B, Fieuws S, et al. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril. 2009;92(1):68–74.\nBalasch J, Creus M, Fabregues F, et al. Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study. Hum Reprod. 1996;11:387–91.\nRedwine DB. Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril. 1999;72:310–5.\nBusacca M, Vignali M. Ovarian endometriosis: from pathogenesis to surgical treatment. Curr Opin Obstet Gynecol. 2003;15:321–6.\nJacobson TZ, Duffy JM, Barlow D, et al. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev. 2010;1:CD001398.\nShimizu Y, Takashima A, Takahashi K, et al. Long-term outcome, including pregnancy rate, recurrence rate and ovarian reserve, after laparoscopic laser ablation surgery in infertile women with endometrioma. J Obstet Gynaecol Res. 2010;36(1):115–8.\nChen Y, Pei H, Chang Y, et al. The impact of endometrioma and laparoscopic cystectomy on ovarian reserve and the exploration of related factors assessed by serum anti-Mullerian hormone: a prospective cohort study. J Ovarian Res. 2014;26(7):108.\nAmerican Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67:817–21.\nNaftalin J, Hoo W, Pateman K, et al. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Hum Reprod. 2012;27:3432–9.\nBergholt T, Eriksen L, Berendt N, et al. Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod. 2001;16:2418–21.\nReinhold C, McCarthy S, Bret PM, et al. Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology. 1996;199:151–8.\nBulletti C, Coccia ME, Battistoni S, et al. Endometriosis and infertility. J Assist Reprod Genet. 2010;27(8):441–7.\nBasta A, Brucka A, Górski J, et al. The statement of Polish Society’s Experts Group concerning diagnostics and methods of endometriosis treatment. Ginekol Pol. 2012;83(11):871–6.\nBrosens I, Puttemans P, Gordts S, et al. Early stage management of ovarian endometrioma to prevent infertility. Facts Views Vis Obgyn. 2013;5(4):309–14.\nZhang X, Liu D, Huang W, et al. Prediction of Endometriosis Fertility Index in patients with endometriosis-associated infertility after laparoscopic treatment. Reprod Biomed Online. 2018;37(1):53–9.\nChapron C, Fritel X, Dubuisson JB. Fertility after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments. Hum Reprod. 1999;14(2):329–32.\nVercellini P, Fedele L, Aimi G, et al. Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system. Hum Reprod. 2006;21(10):2679–85.\nLi XY, Chao XP, Leng JH, et al. Risk factors for postoperative recurrence of ovarian endometriosis: long-term follow-up of 358 women. J Ovarian Res. 2019;12(1):79.\nFlyckt R, Kim S, Falcone T. Surgical management of endometriosis in patients with chronic pelvic pain. Semin Reprod Med. 2017;35(1):54–64.\nJones KD, Sutton CJ. Pregnancy rates following ablative laparoscopic surgery for endometriomas. Hum Reprod. 2002;17(3):782–5.\nMilingos S, Kallipolitis G, Loutradis D, et al. Factors affecting postoperative pregnancy rate after endoscopic management of large endometrioma. Int J Gynaecol Obstet. 1998;63(2):129–37.\nBiacchiardi CP, Piane LD, Camanni M, et al. Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons. Reprod Biomed Online. 2011;23(6):740–6.\nAlborzi S, Keramati P, Younesi M, et al. The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas. Fertil Steril. 2014;101(2):427–34.\nHarb HM, Gallos ID, Chu J, et al. The effect of endometriosis on in vitro fertilization outcome: a systematic review and meta-analysis. BJOG. 2013;120(11):1308–20.\nYoung K, Fisher J, Kirkman M. Endometriosis and fertility: women’s accounts of healthcare. Hum Reprod. 2016;31(3):554–62.\nOpøien HK, Fedorcsak P, Omland AK, et al. In vitro fertilization is a successful treatment in endometriosis-associated infertility. Fertil Steril. 2012;97(4):912–8.\nBarnhart K, Dunsmoor-Su R, Coutifaris C. Effect of endometriosis on in vitro fertilization. Fertil Steril. 2002;77(6):1148–55.\nBrosens I. Endometriosis and the outcome of in vitro fertilization. Fertil Steril. 2004;81(5):1198–200.\nOlivennes F. Results of IVF in women with endometriosis. J Gynecol Obstet Biol Reprod (Paris). 2003;32(8 Pt 2):S45–7.\nSomigliana E, Berlanda N, Benaglia L, et al. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimullerian hormone level modifications. Fertil Steril. 2012;98(6):1531–8.\nD’Hooghe TM, Debrock S, Hill JA, et al. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003;21(2):243–54.\nLee DY, Young Kim N, Jae Kim M, et al. Effects of laparoscopic surgery on serum anti-Mullerian hormone levels in reproductive-aged women with endometrioma. Gynecol Endocrinol. 2011;27(10):733–6.\nPractice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012;98(3):591–8.\nBazot M, Fiori O, Darai E. Adenomyosis in endometriosis- prevalence and impact on fertility: evidence from magnetic resonance imaging. Hum Reprod. 2006;21(4):1101–2 (author reply 1102–3).\nZeng C, Xu JN, Zhou Y, et al. Reproductive performance after surgery for endometriosis: predictive value of the revised American Fertility Society classification and the endometriosis fertility index. Gynecol Obstet Invest. 2014;77(3):180–5.\nAdamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril. 2010;94(5):1609–15.\nSikora J, Smycz-Kubańska M, Mielczarek-Palacz A. The involvement of multifunctional TGF-β and related cytokines in pathogenesis of endometriosis. Immunol Lett. 2018;201:31–7.\nYoung VJ, Brown JK, Saunders PT, et al. The role of the peritoneum in the pathogenesis of endometriosis. Hum Reprod Update. 2013;19(5):558–69.\nAcknowledgements\nWe appreciate the staff at the Peking Union Medical College Hospital for their diligent clinical work and precise data recording in the cases we reported in this article. We thank all the participants in the study.\nFunding\nOur work and the journal’s Rapid Service Fee were supported by the National Key R&D Program of China (No. 2017YFC1001200), National Natural Science Foundation of China (No. 81501237), and 2016 PUMCH Science Fund for Junior Faculty (No. PUMCH-2016-2.2).\nAuthorship\nAll named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.\nAuthorship Contributions\nXY-L and JH-L developed the idea for the project. The study was designed by XY-L and TT-S, and SK-C, JJ-Z, Y-D, JH-S, SZ-J, and YS-W performed the data analysis and took full responsibility for the integrity of the data. TT-S, SK-C, and XY-L drafted the manuscript with inputs and critical discussion from JH-L and XY-L. The final version has been approved by all authors.\nDisclosures\nTing-Ting Sun, Si-Kai Chen, Xiao-Yan Li, Jun-Ji Zhang, Yi Dai, Jing-Hua Shi, Shuang-Zheng Jia, Yu-Shi Wu, and Jin-Hua Leng have nothing to disclose.\nCompliance with Ethics Guidelines\nThis study was approved by the Ethics Committee of Peking Union Medical College Hospital (JS-1722). This study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants.\nData Availability\nThe datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.\nAuthor information\nAuthors and Affiliations\nCorresponding authors\nAdditional information\nDigital Features\nTo view digital features for this article go to https://doi.org/10.6084/m9.figshare.11968545.\nRights and permissions\nAbout this article\nCite this article\nSun, TT., Chen, SK., Li, XY. et al. Fertility Outcomes After Laparoscopic Cystectomy in Infertile Patients with Stage III–IV Endometriosis: a Cohort with 6–10 years of Follow-up. Adv Ther 37, 2159–2168 (2020). https://doi.org/10.1007/s12325-020-01299-w\nReceived:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s12325-020-01299-w","source_license":"CC0","license_restricted":false}