La résection de l’endométriose profonde sans atteinte digestive améliore-t-elle les résultats de la fécondation in vitro ? Une étude retrospective

L. Mounsambote, Mounsambote L, Cohen J, J. Cohen, Jérémie F. Cohen, Sofiane Bendifallah, S. Bendifallah, Bendifallah S, Emmanuelle Mathieu d’Argent, d'Argent EM, E Mathieu d'Argent, Selleret L, Lise Selleret, L. Selleret, N Chabbert-Buffet, Nathalie Chabbert‐Buffet, Chabbert-Buffet N, Marcos Ballester, M Ballester, Ballester M, J.‐M. Antoine, Antoine JM, J M Antoine, Émile Daraï, E. Daraï, Daraï E
Gynecologie, obstetrique, fertilite & senologie · 2017 · vol. 45(1) , pp. 15–21 · doi:10.1016/j.gofs.2016.12.008 · PMID:28238309 · W2584453907
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This retrospective study investigated whether deep endometriosis resection without digestive tract involvement improves in vitro fertilization outcomes.

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Abstract

ObjectivesTo evaluate the impact of complete removal of endometriosis in case of deep infiltrative endometriosis without digestive involvement, on in vitro fertilization outcomes.MethodsRetrospective monocentric study. We included infertile women with deep infiltrative endometriosis without colorectal involvement that underwent IVF. Women were divided in two groups, following their history: "surgery" when they underwent complete endometriosis resection before IVF and "without surgery" when they underwent IVF without endometriosis removal. We analysed IVF outcomes considering pregnancy rates per cycle and cumulative pregnancy rates per patient.ResultsWe included 72 patients: 35 in the "surgery" group and 37 in the "without surgery" group. Women in the two groups were comparable in terms of baseline characteristics (age, body mass index, anti-Müllerian hormone, antral follicular count), endometriosis localizations and in vitro fertilization parameters. Cumulative pregnancy rates per patient were similar in both groups (40 % in the "surgery" group and 41 % in the "without surgery" group; P=1). Clinical pregnancy rate per cycle were also comparable groups (24 % in the "surgery" group and 28 % in the "without surgery" group; P=0.67). Surgery performed was comparable in women that became pregnant and in women that did not. Age was lower in women that became pregnant (P=0.01) and there were more pregnancy obtained in women under 35 years.ConclusionIn women with deep infiltrative endometriosis without digestive involvement, in vitro fertilization outcomes were not impacted by surgery. Therapeutic choice between IVF or surgery as first-line treatment remains thus questionable and shall be guided by other influencing factors, such as pain symptomatology, age, tubal permeability, ovarian reserve, partner's sperm characteristics and woman's choice.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Fertilization in Vitro Infertility, Female Treatment Outcome Adult Age Factors Endometriosis Endometriosis Female Humans Infertility, Female Infertility, Female Pregnancy Pregnancy Rate Retrospective Studies

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