The Role of Intrauterine Insemination in the Therapy of Infertile Women with Endometriosis

Purpose Laparoscopy is considered the gold standard for the diagnosis and treatment of endometriosis. Controlled ovarian hyperstimulation-intrauterine insemination (COH-IUI) is often used to treat women with infertility associated with endometriosis. The objective of the study was to assess the pregnancy rate following surgery, and 6 month GnRH analogue (GnRH-a) therapy, and to assess whether a combined approach with laparoscopic surgery and GnRH-a followed by COH-IUI can improve the overall pregnancy rate. Methods A prospective study was performed on 119 infertile patients who underwent laparoscopic surgery and GnRH-a therapy for endometriosis and returned for a follow-up for a period of time between one and 10 years. Results The pregnancy rate attained after the integrated laparoscopy–GnRH-a–COH-IUI approach was 51.6%. The pregnancy rate after surgery and GnRH-a therapy was significantly lower (41.8%). The fecundity rate for spontaneous conception within 6 months of laparoscopy and GnRH-a treatment (27%) was significantly higher (P<.05) than for the following intervals. Cumulative fecundity in women aged older than 35 was significantly lower than in younger women. Conclusions In patients with endometriosis-associated infertility, surgery and GnRH-a therapy followed by COH-IUI is more effective than surgery and GnRH-a therapy. When patients fail to conceive spontaneously, after a maximum of one year following laparoscopic surgery and GnRH-a, COH-IUI or In Vitro Fertilization Embryo Transfer (IVF-ET) should be recommended.