Deep Endometriosis: the Involvement of Multiple Pelvic Compartments Is Associated with More Severe Pain Symptoms and Infertility

Endometriosis can be classified into three phenotypes: superficial, ovarian, and deep. Deep endometriosis (DE) has been associated with more severe pain symptoms, although no large-scale studies have evaluated the association between pain intensity and infertility and the different compartments of the pelvis affected by superficial and DE. This retrospective study included 1116 women who underwent laparoscopy for endometriosis treatment at two referral centers between 2009 and 2019. For the evaluation of each symptom, patients were divided according to their visual analog scale score (< 7 and ≥ 7) and fertility status. On multiple logistic regression, severe dysmenorrhea and dyschezia were correlated with DE of the posterior compartment alone (odds ratio (OR) = 1.6, confidence interval (CI) 1.09–2.34, and p = 0.02 and OR = 2.09, CI 1.36–3.23, and p < 0.01, respectively) and in combination with other compartments. DE of the posterior and lateral compartments had the most consistent statistical power (OR = 3.55 for dysmenorrhea and OR = 4.4 for dyschezia). Infertility was associated with DE of the posterior compartment alone (OR = 1.6, CI 1.06–2.54, p = 0.04) and in combination with the anterior compartment (OR = 2.62, CI 1.29–5.29, p < 0.01), with the combination of posterior and anterior compartment having the highest OR value. Severe dyschezia and infertility were also correlated with the presence of multiple localizations of DE (p = 0.04 and p < 0.01). This study confirms the association between DE and severe pain symptoms as well as the influence of the number of DE compartments on the severity of symptoms and the chance of infertility. Similar content being viewed by others Data Availability The authors declare that all data and material used in this research are available for consultation. Code Availability Not applicable.

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We would like to thank Cleyton Zanardo for the statistical analysis and Editage (www.editage.com) for English language editing. Author information Authors and Affiliations Contributions Conceptualization and methodology: Tainá Pezzin Rocha and Mauricio Simões Abrão. Formal analysis and investigation: Tainá Pezzin Rocha and Marina Paula Andres. Writing-original draft preparation: Tainá Pezzin Rocha. Writing-review and editing: Tainá Pezzin Rocha and Marina Paula Andres. Supervision: Marina Paula Andres, Mauricio Simões Abrão, Francisco Carmona, and Edmund Chada Baracat. Corresponding author Ethics declarations Ethics Approval This study was approved by the institutional review board of Hospital das Clinicas—HC-FMUSP (CAPPesq 3.079.709) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. Consent to Participate This study was exempt from the informed consent form by IRB, since the data used were retrieved from medical records and no additional patient intervention was performed. Consent for Publication Not applicable. Conflict of Interest The authors declare no competing interests. Additional information Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Rocha, T.P., Andres, M.P., Carmona, F. et al. Deep Endometriosis: the Involvement of Multiple Pelvic Compartments Is Associated with More Severe Pain Symptoms and Infertility. Reprod. Sci. 30, 1668–1675 (2023). https://doi.org/10.1007/s43032-022-01104-9 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s43032-022-01104-9