Bowel complications of deep endometriosis during pregnancy or in vitro fertilization

OBJECTIVE: To review bowel complications caused by deep endometriosis during pregnancy or in vitro fertilization (IVF). DESIGN: Three case reports and a systematic review. SETTING: A tertiary referral center for deep endometriosis surgery. PATIENT(S): Three case reports of bowel perforation or occlusion during pregnancy caused by deep endometriosis. INTERVENTION(S): A PubMed search was conducted to identify complications of deep endometriosis during pregnancy or IVF. The literature search identified 13 articles. According to these, 12 articles described 12 bowel complications caused by progression of deep endometriosis during pregnancy, and 1 article described six cases of bowel occlusion during IVF. RESULT(S): In 12 of 15 women, complications occurred during the third trimester of pregnancy, whereas 3 of 15 women presented with complications in the postpartum period. All complications during IVF occurred during stimulation. No specific factors that could predict these complications were identified, leading to the conclusion that endometriosis complications that occur in pregnancy or in IVF patients are probably underreported. CONCLUSION(S): Bowel complications during pregnancy or IVF stimulation may occur in women with deep endometriosis. This suggests that the endocrine environment of pregnancy does not prevent progression, at least in some women. These complications are rare, although probably underreported.