Surgery for endometriosis-associated infertility: a pragmatic approach

Paolo Vercellini, Edgardo Somigliana, Paola Viganò, Abbiati A, Annalisa Abbiati, Giussy Barbàra, Giussy Barbara, Crosignani PG, P. G. Crosignani, Pier Giorgio Crosignani
Human Reproduction · 2008 · vol. 24(2) , pp. 254–269 · doi:10.1093/humrep/den379 · PMID:18948311 · W2129744763
article OA: bronze CC0 ⤵ 220 in-corpus citations
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This pragmatic analysis estimates the overall conception rate increase from laparoscopic surgery for endometriosis-associated infertility to be 10-25%, with limited benefit from peritoneal lesion excision and questionable value from rectovaginal endometriosis excision.

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Abstract

Laparoscopic treatment for endometriosis-associated infertility is gaining widespread popularity supported mostly by uncontrolled studies, but the purported benefit of surgery may be overvalued. We have therefore analysed the best available evidence with the aim of defining an approximate estimate of the effect size of conservative surgery for infertile women with endometriosis in various clinical conditions. The overall increase in post-operative likelihood of conception over background pregnancy rate may be estimated to be between 10 and 25%. The effect of surgery for peritoneal lesions is limited, and an estimate of benefit should be decreased by the fact that preoperative identification of the subjects actually with the condition is unfeasible. The benefit of excision of ovarian endometriomas is difficult to define due to multiple confounding factors and methodological drawbacks in the considered studies. Excision of rectovaginal endometriosis is of doubtful value and associated with worrying morbidity. The role of surgery before, after or as an alternative to IVF needs clarification. In conclusion, the absolute benefit increase of surgery for endometriosis-associated infertility appears smaller than previously believed. Complete and detailed information on risks and benefits of treatment alternatives must be offered to infertile patients to allow unbiased choices between possible options.

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Condition tags

endometriosisbowel_endometriosisinfertility

MeSH descriptors

Endometriosis Infertility, Female Chemotherapy, Adjuvant Chemotherapy, Adjuvant Endometriosis Endometriosis Endometriosis Female Fertilization in Vitro Gynecologic Surgical Procedures Gynecologic Surgical Procedures Humans Infertility, Female Infertility, Female Laparoscopy Laparoscopy Practice Guidelines as Topic Pregnancy Pregnancy Rate Randomized Controlled Trials as Topic

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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Cited by (50)

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