Outcome of Endometriosis Treatment In Infertile Patients In A Tertiary Level Hospital

Florida Rahman, Nilufar Sultana, Fatema Rahman, Ratna Paul, Umma Salma, Farida Yeasmin, Nafisa Jesmin
In: Journal of Dhaka Medical College · 2024 · vol. 32(1) , pp. 9–15 · doi:10.3329/jdmc.v32i1.76403 · W4403794860
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-07-14 ⓘ

This study assessed the outcomes of surgical and conservative fertility treatments in 144 infertile patients with endometriosis, finding that the condition is associated with decreased ovarian reserve and diminished response to ovarian stimulation.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-14 · read from full text ⓘ

This observational study evaluated outcomes of treatment strategies for 144 infertile women with endometriosis treated at a tertiary reproductive endocrinology unit in Dhaka between 2018 and 2021. Patients underwent clinical and ultrasound staging and hormonal assessment, with laparoscopic surgery (primarily cystectomy) selected for ovarian endometriomas >4 cm and ovulation induction (with or without prior GnRH agonist) used for smaller/no ovarian endometriomas, followed by further fertility planning based on ovarian reserve, tubal patency, and male factor. The study found most participants had primary infertility, dysmenorrhea and chronic pelvic pain were common, and bilaterality of endometrioma was associated with decreased serum AMH, while endometriosis was described as contributing to diminished ovarian stimulation response. The paper’s limitation is its observational design, with no control group reported, and it concludes that endometriosis-related ovarian reserve reduction makes fertility treatment challenging. This paper is centrally about endometriosis—specifically treatment outcomes for infertile patients in a tertiary hospital.

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Abstract

Introduction: Prevalence of endometriosis is 6-10% in reproductive-age females. Around 25-35% of infertile women may be affected by endometriosis. Modalities of treatment for infertile patients depends on the stage of the disease. It starts from ovulation inducing drug to advanced ART. The objective of this study was to assess the outcome of surgical treatment in infertile, endometriosis patients. Materials and Methods: It was an observational study, which was conducted at Reproductive Endocrinology and infertility Unit, Dhaka Medical College. Total 144 patients were included during July 2018 to July 2021, aged 20-40 yrs. All the demographic variables, clinical and sonographic findings, and hormonal assessment were done. Then, staging was done by clinical pelvic assessment, and ultrasonographic findings. Patients who had ovarian endometrioma, more than 4 cm, were selected for laparoscopic surgery. In patients whose endometrioma was less than 4 cm, or had no ovarian endometrioma, were selected for ovulation induction with or without prior GnRH agonist therapy. Further infertility management were planned according to ovarian reserve, tubal patency, and male factor. Result: Mean age of the patients were 28.30±4.95 yrs. 75.0% patients had primary infertility. Dysmenorrhea was the most common symptom (86.96%), followed by chronic pelvic pain (81.16%). Bilaterality of endometrioma was associated with decreased serum AMH. Laparoscopic surgery was the mainstay of treatment, Cystectomy was done in 58% patients. Conservative treatment was done in remaining patients. Fertility enhancing treatment was done by ovulation inducing drug -letrozole, GnRH agonist, followed by controlled ovarian stimulation and followed by IUI. IVF was advised for fertility management in 26patients (18.06%). Conclusion: Endometriosis is not only associated with decreased ovarian reserve but also responsible for diminished response to ovarian stimulation. So, it is a great challenge to obtain successful fertility treatment for this group of patients. J Dhaka Med Coll. 2023; 32(1) : 9-15
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Keywords

Endometriosis, infertilityAbstract

Introduction

Prevalence of endometriosis is 6-10% in reproductive-age females. Around 25-35% of infertile women may be affected by endometriosis. Modalities of treatment for infertile patients depends on the stage of the disease. It starts from ovulation inducing drug to advanced ART. The objective of this study was to assess the outcome of surgical treatment in infertile, endometriosis patients.

Materials and methods

It was an observational study, which was conducted at Reproductive Endocrinology and infertility Unit, Dhaka Medical College. Total 144 patients were included during July 2018 to July 2021, aged 20-40 yrs. All the demographic variables, clinical and sonographic findings, and hormonal assessment were done. Then, staging was done by clinical pelvic assessment, and ultrasonographic findings. Patients who had ovarian endometrioma, more than 4 cm, were selected for laparoscopic surgery. In patients whose endometrioma was less than 4 cm, or had no ovarian endometrioma, were selected for ovulation induction with or without prior GnRH agonist therapy. Further infertility management were planned according to ovarian reserve, tubal patency, and male factor.

Result

Mean age of the patients were 28.30±4.95 yrs. 75.0% patients had primary infertility. Dysmenorrhea was the most common symptom (86.96%), followed by chronic pelvic pain (81.16%). Bilaterality of endometrioma was associated with decreased serum AMH. Laparoscopic surgery was the mainstay of treatment, Cystectomy was done in 58% patients. Conservative treatment was done in remaining patients. Fertility enhancing treatment was done by ovulation inducing drug -letrozole, GnRH agonist, followed by controlled ovarian stimulation and followed by IUI. IVF was advised for fertility management in 26patients (18.06%).

Conclusion

Endometriosis is not only associated with decreased ovarian reserve but also responsible for diminished response to ovarian stimulation. So, it is a great challenge to obtain successful fertility treatment for this group of patients. J Dhaka Med Coll. 2023; 32(1) : 9-15 418 334

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endometriosisendometriomachronic_pelvic_paindysmenorrheainfertility

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