Endometriosis: Surgical Management and Optimal Ovarian Stimulation Protocol for ART

Laparoscopy is the gold standard for the definitive diagnosis and management of endometriosis. The surgical goal in endometriosis is to remove all visible disease and at the same time conserve as much ovarian tissue as possible. Any endometrioma >4 cm should be excised and sent for histopathology to rule out malignancy. Excision or ablation of endometriotic lesions and adhesiolysis improves fertility and increases pregnancy rates of those continuing more than 20 weeks in minimal to mild endometriosis. Surgical clearance of endometriotic disease improves spontaneous pregnancy rates in moderate to severe endometriosis. Surgery in expert hands decreases chances of loss of normal ovarian reserves. IUI or IVF/ICSI improves pregnancy rates if used after cystectomy. Preoperative treatment with GnRH agonist for 3–4 months before IVF/ICSI in patients with endometriosis improves pregnancy rates. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Evers JL. The second-look laparoscopy for evaluation of the result of medical treatment of endometriosis should not be performed during ovarian suppression. Fertil Steril. 1987;47(3):502–4. Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400–12. Jacobson TZ, Barlow DH, Koninckx PR, Olive D, Farquhar C. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev. 2002;(4):CD001398. Lohn FH, Tan AT, Kumar J, Ng SC. Ovarian response after laparoscopic ovarian cystectomy for endometriotic cysts in 132 monitored cycles. Fertil Steril. 1999;72(2):316–21. Fedele L, Bianchi S, Zanconato G, Berlanda N, Raffaelli R, Fontana E. Laparoscopic excision of recurrent endometriomas: long term outcome and comparison with primary surgery. Fertil Steril. 2006;85(3):694–9. Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev. 2004;(3):CD003678. Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2014;3:CD009590. Sallam HN, Garcia-Velasco JA, Dias S, Arici A. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev. 2006;(1)CD004635. Benschop L, Farquhar C, van der Poel N, Heineman MJ. Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev. 2010;(11)CD008571. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2015 Springer India About this chapter Cite this chapter Jha, U.P., Kaur, R., Sharma, N., Agrawal, R., Lal, P. (2015). Endometriosis: Surgical Management and Optimal Ovarian Stimulation Protocol for ART. In: Ghumman, S. (eds) Principles and Practice of Controlled Ovarian Stimulation in ART. Springer, New Delhi. https://doi.org/10.1007/978-81-322-1686-5_28 Download citation DOI: https://doi.org/10.1007/978-81-322-1686-5_28 Publisher Name: Springer, New Delhi Print ISBN: 978-81-322-1685-8 Online ISBN: 978-81-322-1686-5 eBook Packages: MedicineMedicine (R0)