Conservative surgery of infertile patients with pelvic endometriosis--factors affecting the pregnancy rate and expectancy

Conservative surgery was used in the treatment of 95 infertile patients with endometriosis who desired to have a child; of these 95 patients, 44 (46.3%) became pregnant after treatment. We studied the postoperative pregnancy rate and the expectancy value for pregnancy and the factors affecting them. The postoperative pregnancy rate was significantly lower in the patients with an infertility period of more than 5 years. As the age of the patients at the time of operation increased, the pregnancy rate decreased; the expectancy value was also significantly lower in patients over 30 years of age. Endometriotic lesions were, in the ovary (77.9%), in the peritoneum (42.1%), and in the uterosacral ligament (42.1%). The rates of pregnancy in patients in Beecham's stages II (43.2%) and III (53.3%) were not statistically significant. The rate was significantly lower in stage IV. Intrapelvic complications were usually myoma of the uterus and cystoma of the ovary. Both pregnancy rate and expectancy value were significantly lower in the patients with pelvic complications. Hormonal therapy combined with conservative surgery gave a higher rate of pregnancy and expectancy value than surgery alone. Thus, the duration of infertility, the age of the patient at the time of operation, intrapelvic complications, and the mode of treatment were key factors affecting the postoperative rate of pregnancy and expectancy.