Endometriosis and infertility Surgery and ART: An integrated approach for successful management

Objectives: Laparoscopy is considered the gold standard for treatment of endometriosis. In vitro fertilization and embryo transfer (IVF–ET)\nis often used to treat women with infertility associated with endometriosis. The objective of the study was to evaluate the pregnancy rate after\nsurgical treatment and to assess whether a combined approach with laparoscopic surgery followed by IVF–ET can improve the ‘‘overall’’\npregnancy rate.\nStudy design: A retrospective observational study was carried out on 107 infertile patients who underwent laparoscopic surgery for\nendometriosis and came at follow-up for a period of time between 1 and 11 years. Sixty-seven patients who did not become pregnant after\nsurgery subsequently underwent IVF–ET.\nResults: The pregnancy rate achieved after the integrated laparoscopy-IVF approach was 56.1%. The pregnancy rate after surgery, was\nsignificantly lower (37.4%). The fecundity rate for spontaneous conceptions within 6 months of laparoscopy (23.2%) was significantly higher\n(P < 0.05) than for the following intervals. The cumulative fecundity in women older than 35 years was significantly lower than in younger\nwomen.\nConclusions: In patients with endometriosis-associated infertility, surgery followed by IVF–ET is more effective than surgery alone. When\npatients fail to conceive spontaneously, after a maximum of 1 year from laparoscopic surgery, IVF should be suggested.