Long-term Recurrence of Endometriosis in Women with Subfertility Caused by Endometriosis: A Comparison of the Efficacy of Surgery and Assisted Reproductive Technology as Fertilization Treatment Approaches

Niloofar Asadzadeh, Shahla Chaichian, Mobina Ziadloo, Shahla Mirgaloy Bayat, Mehrdad Sheikhvatan
In: Shiraz E-Medical Journal · 2020 · vol. 22(1) · doi:10.5812/semj.99676 · W3043368347
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study found that neither laparoscopic surgery nor assisted reproductive technology significantly affected the long-term recurrence rate of endometriosis in subfertile women.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

The study compared long-term recurrence of endometriosis in subfertile women treated either with assisted reproductive technology (ART, n=9) or surgery (n=42), assessing baseline characteristics and endometriosis stage, then tracking recurrence over follow-up. Recurrence rates were 44.4% in the surgery group and 28.6% in the ART group, with no significant difference between groups, and recurrence-free proportions at 1, 2, and 3 years similarly did not show significant separation; the mean time to recurrence was also not significantly different. Cox proportional hazards modeling including multiple baseline variables found that the fertilization method (ART vs surgery) did not affect long-term recurrence (OR 1.428, 95% CI 0.177–9.900, P=0.784), and symptom profiles of recurrence were not significantly different. A key caveat is the small ART sample size (n=9) and imbalance in age between groups (ART candidates were younger). This paper is centrally about endometriosis—recurrence after surgery versus ART in subfertile women with endometriosis.

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Abstract

Background: The evolution of fertility treatment methods such as laparoscopic surgery and assisted reproductive technology (ART) leads to an increased chance for conception in women with endometriosis. However, it is still not clear which treatment is more likely to result in endometriosis recurrence. Objectives: The current study aimed at assessing the recurrence rate of endometriosis and its main determinants following fertility treatment with surgery or ART. Methods: The current historical cohort study was conducted on 51 consecutive women with endometriosis undergoing fertilization procedures, including laparoscopic surgery (n = 42) and ART (n = 9) in Tehran from 2006 to 2016. All patients with complete hospital records were enrolled in the study. The patients in the two groups were followed up for five years for endometriosis recurrence. Results: Within the follow-up time, the rate of endometriosis recurrence in patients of the surgery and ART groups was 28.6% and 44.4%, respectively, indicating no significant difference between the groups (P = 0.436). In this regard, the 1-, 2-, and 3-year recurrence-free survival rate in the ART group was 87.5%, 50.0%, and 50.0%, and in the surgery group was 96.9%, 90.6%, and 70.5%, respectively. Using the Cox proportional hazard modeling adjusted for baseline variables, the method of fertilization (ART or surgery) could not affect the rate of long-term recurrence of endometriosis (odds ratio = 1.428, 95% confidence interval: 0.177 - 9.900, P = 0.784). Conclusions: The method of fertilization treatment-e g, surgery, and ART- may not affect the rate of endometriosis recurrence in women with subfertility caused by endometriosis.
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The two study groups included patients undergoing ART (n = 9) or surgery (n = 42). As summarized in Table 1, there was no significant difference in baseline variables including mean BMI, education level, occupational status, number of parity or abortion, history of ectopic pregnancy, and number of children between the two groups; however, the candidates for ART were significantly younger than the ones undergoing surgery. Regarding the stage of endometriosis, stage I was found in 19.1% and 22.2%, stage II in 26.2% and 22.2%, stage III in 9.6% and 11.1%, and stage IV in 45.2% and 44.4% of the ART and surgery groups, respectively with no significant difference (P = 0.991). Within the follow-up time, the rate of endometriosis recurrence was 28.6% and 44.4% in the surgery and ART groups, respectively, indicating no significant difference between the groups (P = 0.436). In this regard, the 1-, 2-, and 3-year recurrence-free rate was 87.5%, 50.0%, and 50.0% in the ART group, and 96.9%, 90.6%, and 70.5% in the surgery group, respectively ( Figure 1). The mean time of recurrence in the ART and surgery groups was 1.1 ± 0.6 and 2.3 ± 1.3 years, respectively, indicating no significant difference between the groups (P = 0.108). As shown in Table 2, there was no significant difference in symptoms of endometriosis recurrence, including chronic pelvic pain, dyspareunia, dysuria, dichasia, catheter-related pain, dysmenorrhea, and AUB between the groups. Using the Cox proportional hazard modeling ( Table 3) and baseline variables including age, BMI, education level, occupational status, stage of endometriosis, number of parity, and history of abortion, the method of fertilization (ART or surgery) could not affect the long-term recurrence rate of endometriosis (OR = 1.428, 95%CI: 0.177 - 9.900, P = 0.784).

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