Recurrent endometriosis and IVF: is it still an enigma?

The recurrence of endometriosis varies between 6% and 67%. If the patient is infertile and has recurrent endometriosis, she could be managed by repeat surgery or assisted reproduction. Given the increasing number of patients with recurrent endometriosis applying for IVF procedure, the aim of this study was to compare IVF outcome in patients who underwent one or more surgeries for endometriosis for the purpose of offering proper counseling to the infertile patients. The authors compared IVF outcome measures between 50 patients once operated for endometriosis with no signs of the disease at the time of IVF procedure, 29 patients also once operated for endometriosis with signs of the disease at the time of IVF procedure, and 47 patience more than once operated for endometriosis. Each group was also compared with a control group of 157 patients with tubal factor infertility. Outcome measures included number of follicles, number of oocytes, mean number of ampoules of gonadotropins, cumulative pregnancy, and live birth rates The rate of cancelled cycles was higher in all three groups of patients with endometriosis compared to the control group, and in addition, significantly higher in patients who underwent two or more endometriosis surgeries. The same applied for the number of oocytes retrieved by puncture and the number of the obtained embryos. The rate of implantation, clinical and multifetal pregnancies, as well as the birth rate per embryo transfer was significantly lower in patients who underwent endometriosis surgery two or more times, compared to all other groups of patients. When it comes to recurrent endometriosis, repeat surgery worsens the IVF outcome and therefore should be avoided. Except in cases of patients experiencing unbearable pain and suspicious ovarian mass findings, a patient with recurrent endometriosis should be immediately included in the IVF procedure without repetitive surgery.