Should we consider integrated approach for endometriosis-associated infertility as gold standard management? Rationale and results from a large cohort analysis

Purpose To evaluate reproductive and maternal–fetal outcomes after integrated approach for endometriosis-associated infertility (EAI).

We retrospectively analyzed reproductive and maternal–fetal outcomes of 277 women affected by EAI, subdividing patients in two groups: in the first one (surgery group), we included all women who underwent laparoscopic surgery for EAI; in the second one (integrated group), we included women who failed to conceive spontaneously after surgery within 6–12 months and underwent in vitro fertilization and embryo transfer (IVF). We evaluated delivery rate (DR), maternal and neonatal outcomes of the first pregnancies, and, finally, the type (spontaneous or IVF) of subsequent pregnancies.

We did not find significant difference regarding DR between surgery and integrated groups. We found significantly lower birth weight (p < 0.001) and gestational age at delivery (p < 0.001) in integrated group respect to surgery group; conversely, we found higher rate of preterm birth (p < 0.001), small for gestational age (p = 0.003), and admission to the neonatal intensive care unit (p < 0.001) respect to surgery group. Finally, 92 women became pregnant for the second time: 8% were spontaneous and 20% were IVF pregnancies.

We suggest the integrated approach as gold standard treatment for carefully selected patients (young, good ovarian reserve, partner with normal semen parameters) affected by EAI. As consequence, IVF should be reserved as the secondary treatment for women who fail to conceive spontaneously after surgery within 6–12 months, since it is able to increase DR significantly. Similar content being viewed by others

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Fertil Steril 105:129–133. https://doi.org/10.1016/j.fertnstert.2015.09.039 Funding The study was not supported by any grant/fund. Author information Authors and Affiliations Contributions VŠ: protocol development and data collection. IV: data analysis and manuscript writing. ASL: manuscript editing. EV-B: project supervision and manuscript editing Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study. Rights and permissions About this article Cite this article Šalamun, V., Verdenik, I., Laganà, A.S. et al. Should we consider integrated approach for endometriosis-associated infertility as gold standard management? Rationale and results from a large cohort analysis. Arch Gynecol Obstet 297, 613–621 (2018). https://doi.org/10.1007/s00404-017-4633-0 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-017-4633-0