Experience of combined treatment of patients with infertility operated for external genital endometriosis

Currently, endometriosis is a common gynecologic disease associated with infertility and possibly with unfavorable pregnancy outcomes. Objective. To show the efficacy of complex treatment of patients with external genital endometriosis suffering from infertility when using gonadotropin-releasing hormone agonists. Material and methods. 238 patients of reproductive age with the diagnosis of external genital endometriosis established during laparoscopy with confirmation of the diagnosis by histologic examination, suffering from primary and secondary infertility were examined. The patients were divided into two groups depending on the treatment performed. The 1st group included 119 patients who underwent only surgical treatment: laparoscopy according to the standard technique (coagulation and excision of foci of external genital endometriosis). The 2nd group included 119 patients who underwent combined treatment: surgical intervention combined with postoperative hormonal therapy with gonadotropin-releasing hormone (GnRH) agonists, in particular, Buserelin-depo 3.75 mg in the form of intramuscular injections at an interval of 28 days. The duration of treatment with gonadotropin-releasing hormone agonists was 6 months. Results. The primary outcome (pregnancy rate) was assessed one year after surgical treatment in both groups. Secondary outcomes (frequency of pain syndrome, dyspareunia, dysmenorrhea, and side effects of treatment) were evaluated monthly for 6 months after surgical treatment. In the 1st group, the incidence of pregnancies finished with labor was 44.5% (n=53). In the 2nd group, 78.9% (n=94) of the patients had a pregnancy that ended in a timely delivery within a year after the combined treatment. Complex treatment of patients with external genital endometriosis suffering from infertility with the use of gonadotropin-releasing hormone agonists increases the probability of pregnancy by 34.4% compared with surgical treatment alone. Conclusion. Suppressive therapy in external genital endometriosis with the use of aGnRH aimed at reducing estrogen levels is pathogenetically justified. Combined (surgical and medical) treatment allows to achieve better results in patients with external genital endometriosis and infertility.